Acute cardiac herniation after radical pleuropneumonectomy

Our plain-English summary of Acute cardiac herniation after radical pleuropneumonectomy, by R.J. Self, R.S. Vaughan (Anaesthesia, 1999).

The study

• Authors: R.J. Self, R.S. Vaughan
• Journal: Anaesthesia
• Published: 1999;54(6):564-6
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Acute cardiac herniation after radical pneumonectomy is extremely rare and is associated with an immediate mortality greater than 50%. We report a patient in whom cardiac herniation produced no signs or symptoms. The heart was returned to its correct position and the pericardial defect was repaired.

In plain English

This case report described a 36-year-old builder who had a right pleuropneumonectomy for mesothelioma, which the article calls mesothelioma of the right lung. The operation removed the right pleura, right lung, diaphragm and pericardium, leaving a 10 by 10 cm hole in the pericardium, the sac around the heart. The article does not report the patient's asbestos exposure. Half an hour after his breathing tube was removed he was stable and pain free. A routine chest X-ray then showed that his heart had slipped through the hole into the right side of the chest (cardiac herniation). His blood pressure stayed around 110/60 mmHg. He was taken back to surgery, the heart was put back in place, and the hole was closed with a synthetic patch. He recovered without problems and went home 10 days later. The authors said the only possible cause was coughing around the time the tube was removed. They wrote that such herniation usually causes sudden circulatory collapse. They added that a case without signs or symptoms appeared to be only the second recorded.

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 36-year-old male builder with mesothelioma (described as mesothelioma of the right lung) who underwent right pleuropneumonectomy; the hospital where surgery took place is not stated beyond the authors' affiliation (University Hospital of Wales, Cardiff, UK); dates not given
• Exposure: The article reports no asbestos exposure history for this patient; it gives only his occupation (builder) and a general background statement that pleural mesothelioma is associated with asbestos exposure
• Main results:
  • Surgery removed the right visceral and parietal pleura, right lung, diaphragm and pericardium, leaving a 10 by 10 cm pericardial defect on the right side
  • After surgery the patient was haemodynamically stable and pain free, with blood pressure around 110/60 mmHg, central venous pressure 0 mmHg and pulse 100 beats per minute, even though herniation had occurred
  • The routine postoperative chest X-ray showed a significant degree of cardiac herniation, with the apex of the heart in the right hemithorax
  • At a repeat right thoracotomy the heart was replaced in the pericardium and the defect closed with a synthetic patch
  • The patient made an uneventful recovery and was discharged home 10 days later
  • The authors considered coughing around the time of extubation the only possible cause in this case
• The authors' conclusion: The authors noted that cardiac herniation usually produces cardiovascular and/or respiratory signs. Because this patient had neither, they wrote that it appeared to be the second such case ever recorded.

Topics

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Pericardial.

Related studies

• Acute postoperative cardiac herniation — K. Kawamukai, F. Antonacci, et al. (2011)
• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients — E.G. Butchart, T. Ashcroft, et al. (1976)
• The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller, et al. (2012)
• The management of the diaphragm during radical surgery for malignant pleural mesothelioma — A.J. Sharkey, R. Bilancia, et al. (2016)

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