Management of cardiac herniation after intrapericardial pneumonectomy

Abstract

Herniation of the heart through a pericardial defect is a rare complication of intrapericardial pneumonectomy that usually manifests itself within 24 postoperative hours. Because mortality is approximately 50%, rapid diagnosis and surgery are recommended. Our patient with cardiac herniation presented with hypotension, airway obstruction, wheezing, and changes on electrocardiogram (ECG). However, in contrast to previous case reports of survivors, surgery was not begun immediately. Repositioning the patient, reducing tidal volume, and instituting therapeutic pneumothorax returned the mediastinum to midline and the heart to the left hemithorax. Vital signs stabilized until the defect in the pericardium was repaired.