Cardiac Herniation Following Extended or Radical Pneumonectomy—an Avoidable Complication?

Abstract

Pericardial defects necessarily occur when the great pulmonary vessels are divided within the pericardial sac or when portions of the pericardium are resected because of direct tumor infiltration. As a result cardiac herniation or strangula tion may develop if the heart prolapses through the surgically created defect in the pericardium. In this report the authors present 5 cases of cardiac herniation following ex tended pneumonectomy. Herniation was left-sided in 3 of 5 patients; all instances occurred within the first twenty-four hours postoperatively. In 3 patients, the complication was associated with change in position for postural drainage, in 2 patients after massive coughing. The initial clinical picture was determined by sudden onset of low cardiac output, cyanosis, tachycardia, and asystole. All pa tients were reexplored without delay. The defects were covered with a substitute patch. After the critical review of the literature and according to their own experience, the authors draw the following conclusions: • Sudden onset of low cardiac output without obvious signs of hemorrhage or cardiac failure is suspicious for cardiac herniation after pneumonectomy. • Change in position onto the operated side, massive coughing, and large pericardium are the main risk factors. • Emergency reoperation and reposition of the heart offers the only chance of survival. • Cardiac herniation is most effectively prevented and can be avoided by patch ing the defect.