A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma

Our plain-English summary of A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma, by S. Sonoda, Y. Kumagawa, E. Inada (Journal of Anesthesia, 2010).

The study

• Authors: S. Sonoda, Y. Kumagawa, E. Inada
• Journal: Journal of Anesthesia
• Published: 2010;24(6):926-9
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 44-year-old man underwent radical thymectomy for malignant thymoma 5 years ago. He subsequently underwent right extrapleural pneumonectomy because a right pleural metastatic lesion had developed. The operation was completed uneventfully. Immediately after arrival at the intensive care unit, the patient appeared restless and in pain. His heart rate increased to 140 bpm and then abruptly decreased to 20-30 bpm concomitant with profound systolic hypotension of 30-40 mmHg. Chest X-ray showed that the heart was shifted into the right thorax. Emergent re-thoracotomy was performed and the heart was found to be malrotated and herniated from an upper defect of the pericardial patch in the right thoracic cavity. The heart was returned to the pericardium and the defect was covered with a pericardial patch. The blood pressure and heart rate became stable. He was transferred to the surgical ward from the intensive care unit on the first postoperative day. The rest of the course was uneventful and the patient was discharged on the seventh postoperative day. The incidence of cardiac herniation after extrapleural pneumonectomy following chemotherapy for malignant pleural mesothelioma has been reported to be around 3%. The risk of cardiac herniation should always be considered, especially after extrapleural pneumonectomy.

In plain English

This article was a case report from an anesthesiology department at Juntendo University in Tokyo, Japan. It described one 44-year-old man with malignant thymoma, not mesothelioma. The article did not report any asbestos exposure. Five years after surgery to remove the thymus, and chemotherapy, he underwent a right extrapleural pneumonectomy because a right pleural lesion had developed. The operation was completed uneventfully. Several minutes after the breathing tube was removed, his systolic blood pressure fell from 110 to 70 mmHg. On arrival in intensive care, his heart rate rose to 140 beats per minute and then dropped to 20 to 30, with systolic pressure of 30 to 40 mmHg. A chest X-ray showed the heart shifted into the right chest. In an emergency second operation, the surgeons found the heart malrotated and herniated through a gap of about 5 cm2 in the pericardial patch. They returned the heart to the pericardium and covered the gap. He was discharged on the seventh postoperative day. The authors concluded that cardiac herniation should be considered when low blood pressure occurs immediately after extrapleural pneumonectomy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 44-year-old man with malignant thymoma who had had a radical thymectomy and chemotherapy for right pleural dissemination 5 years earlier; treated at Juntendo University, Tokyo, Japan
• Exposure: No asbestos exposure is reported. The event studied was a right extrapleural pneumonectomy performed because a right pleural lesion had developed after malignant thymoma.
• Main results:
  • Several minutes after extubation, the patient's systolic blood pressure fell from 110 to 70 mmHg. This was reversed with fluids and a dopamine infusion.
  • In the intensive care unit, the patient's heart rate rose to 140 bpm and then abruptly fell to 20 to 30 bpm, with systolic blood pressure of 30 to 40 mmHg.
  • A chest X-ray showed the patient's heart shifted into the right thorax.
  • At emergency re-thoracotomy, the heart was malrotated and herniated through an upper defect of about 5 cm2 in the pericardial patch. The defect was caused by the patch shifting to the lower side.
  • The patient recovered and was discharged on the seventh postoperative day.
• The authors' conclusion: The authors concluded that cardiac herniation should be considered in the differential diagnosis of hypotension occurring immediately after extrapleural pneumonectomy. They suggested that in this patient the herniation possibly occurred when he was turned from the lateral decubitus to the supine position.

Topics

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Chest X-Ray, Thorax, Thoracotomy, Pericardial, Pericardium, Chemotherapy, Pleural Mesothelioma.

Related studies

• Acute cardiac herniation after radical pleuropneumonectomy — R.J. Self, R.S. Vaughan (1999)
• Acute postoperative cardiac herniation — K. Kawamukai, F. Antonacci, et al. (2011)
• Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma — E. de Bree, S. van Ruth, et al. (2002)
• Pleural metastasis of malignant thymoma. A pitfall in the CT-diagnosis of pleural mesothelioma — J. Görich, S.A. Beyer-Enke, et al. (1989)
• Extended pleurectomy decortication for thymoma with pleural dissemination — N. Imanishi, Y. Nabe, et al. (2019)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)

Browse return to medical research.