Cardiac herniation after left intrapericardial pneumonectomy

Alimi, Faouzi; Marzouk, Mohamed; Mgarrech, Imene; Chemchik, Haythem; Limayem, Faouzi

doi:10.1177/0218492315589199

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…Although cardiac herniation is a rare event, it must be considered with any operation involving a pericardial incision or resection [6]. Although the incidence is similar on both sides of the heart, the mechanism of hemodynamic failure differs [7]. A right sided herniation can present in a variety of ways: asymptomatic, severe hypotension, reflex tachycardia or superior vena cava syndrome (dependent on the amount of right ventricular compression).…”

Section: Discussionmentioning

confidence: 99%

Case report: cardiac herniation following robotic-assisted thymectomy

Espey

Acosta

Kolarczyk

et al. 2020

J Cardiothorac Surg

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Background: The first reported case of cardiac herniation was in 1948 and occurred following pericardiectomy during a lung cancer resection. Although rare, this potentially fatal surgical complication may occur following any operation in which a pericardial incision or resection is performed. The majority of literature on cardiac herniation involves case reports after intrapericardial pneumonectomy. Currently, there are no reports of cardiac herniation after thymectomy with pericardial resection. Case presentation: A 44-year-old Asian female with symptomatic myasthenia gravis was referred for thymectomy. Originally thought to have Bell's Palsy, her symptoms began with right eyelid drooping and facial weakness. Over time, she developed difficulty holding her head up, upper extremity weakness, difficulty chewing and dysarthria. These symptoms worsened with activity. She was found to have positive acetylcholine receptor binding antibody on her myasthenia gravis panel. A preoperative CT scan demonstrated a 3.5 cm × 2 cm anterior mediastinal mass along the right heart border and phrenic nerve. A complete thymectomy, via right-sided robotic-assisted approach was performed en bloc with a portion of the right phrenic nerve and a 4 cm × 4 cm portion of pericardium overlying the right atrium and superior right ventricle. Upon undocking of the robot and closure of the port sites, the patient became acutely hypotensive (lowest recorded blood pressure 43/31 mmHg). The camera was reinserted and demonstrated partial cardiac herniation through the anterior pericardial defect toward the right chest. An emergent midline sternotomy was performed and the heart was manually reduced. The patient's hemodynamics stabilized. A vented Gore-Tex 6 cm × 6 cm patch was sewn along the pericardial edges with interrupted 4-0 prolene to close the pericardial defect. Conclusion: This potentially fatal complication, although rare, should always be considered whenever there is hemodynamic instability entry or resection of the pericardium during surgery. We now routinely sew in a pericardial patch using our robotic surgical system for any defect over 3 cm × 3 cm that extends from the mid-to inferior portions of the heart.

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Section: Discussionmentioning

confidence: 99%

Case report: cardiac herniation following robotic-assisted thymectomy

Espey

Acosta

Kolarczyk

et al. 2020

J Cardiothorac Surg

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“…Although it looks similar on both sides of the heart, the pathophysiology mechanism leading to hemodynamic failure is different ( 115 ). On the right side, the protrusion of the heart through an ignored or inadequately closed pericardial sac defect usually following a pericardiotomy may enable the heart to rotate its tip to the right around the superior vena cava/inferior vena cava axis, resulting in torsion of these large vessels and leading to a dramatic reduction of cardiac preload and thus cardiac output ( 116 ).…”

Section: Epidemiologymentioning

confidence: 99%

Cardiogenic shock among cancer patients

Curtiaud

Delmas

Gantzer

et al. 2022

Front. Cardiovasc. Med.

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Sophisticated cancer treatments, cardiovascular risk factors, and aging trigger acute cardiovascular diseases in an increasing number of cancer patients. Among acute cardiovascular diseases, cancer treatment, as well as the cancer disease itself, may induce a cardiogenic shock. Although increasing, these cardiogenic shocks are still relatively limited, and their management is a matter of debate in cancer patients. Etiologies that cause cardiogenic shock are slightly different from those of non-cancer patients, and management has some specific features always requiring a multidisciplinary approach. Recent guidelines and extensive data from the scientific literature can provide useful guidance for the management of these critical patients. Even if no etiologic therapy is available, maximal intensive supportive measures can often be justified, as most of these cardiogenic shocks are potentially reversible. In this review, we address the major etiologies that can lead to cardiogenic shock in cancer patients and discuss issues related to its management.

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“…Cardiac herniation after pneumonectomy occurs within 24 h of the surgery in most cases. 2,3 Factors that may increase the likelihood of cardiac herniation after pneumonectomy include cough, positive-pressure ventilation of the lung, the rapid expansion of the contralateral lung, and chest tube suction. 4 Risk factors for cardiac herniation include preoperative chemotherapy and a history of smoking.…”

Section: Commentmentioning

confidence: 99%

A case of cardiac herniation after right pneumonectomy

Inoue

Yotsukura

Yoshida

et al. 2022

Asian Cardiovasc Thorac Ann

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A cardiac herniation is a rare but life-threatening complication after pneumonectomy. In most cases, it manifests suddenly as severe hypotension and cardiac arrest within 24 h of pneumonectomy. Here, we report a case of sudden-onset cardiac herniation after right pneumonectomy during which the pericardium was incised. The diagnosis was made immediately based on chest X-ray and electrocardiogram findings, and the heart was repositioned by repeat thoracotomy as an urgent life-saving measure. Surgeons should be aware of this potential surgical complication as well as its clinical manifestations, given that delayed diagnosis would directly lead to a fatal outcome.

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Cardiac herniation after left intrapericardial pneumonectomy

Cited by 8 publications

References 5 publications

Case report: cardiac herniation following robotic-assisted thymectomy

Case report: cardiac herniation following robotic-assisted thymectomy

Cardiogenic shock among cancer patients

A case of cardiac herniation after right pneumonectomy

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