Acute postoperative cardiac herniation

Our plain-English summary of Acute postoperative cardiac herniation, by K. Kawamukai, F. Antonacci, S. Di Saverio, et al (Interactive Cardiovascular and Thoracic Surgery, 2011).

The study

• Authors: K. Kawamukai, F. Antonacci, S. Di Saverio, M. Boaron
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2011;12(1):73-4
• Type of article: Case report
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Acute herniation of the heart is an uncommon complication in patients undergoing pneumonectomy with associated pericardial resection. We report the case of a postoperative cardiac herniation after a right extrapleural pneumonectomy following neoadjuvant chemotherapy for malignant pleural mesothelioma. After surgery the patient was completely asymptomatic, but a postoperative chest X-ray revealed unexpected massive dextrocardia. The patient was immediately brought back to the operating room: a cardiac herniation was found to be caused by a partial dehiscence of the pericardial prosthesis suture. The defect was repaired without consequences.

In plain English

This article was a case report about one patient. A 55-year-old man with malignant pleural mesothelioma had chemotherapy and then an operation called a right extrapleural pneumonectomy. During the operation, the surgeons removed part of the right pericardium, the sac around the heart, and replaced it with a tailored patch made of polytetrafluoroethylene (PTFE). After surgery the patient had no symptoms, and his circulation stayed stable. However, a routine chest X-ray taken one hour after surgery unexpectedly showed his heart shifted far to the right side. He was taken straight back to the operating room. There the surgeons found that the heart had herniated because the stitches holding the pericardial patch had partly come apart. They re-attached the patch with new stitches. A repeat X-ray showed the heart back in its correct position, and his recovery afterward was uneventful. The authors concluded that surgeons should consider this complication after this kind of surgery even when the patient has no symptoms. The report did not discuss asbestos exposure.

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 55-year-old man treated in Bologna, Italy, who had a right extrapleural pneumonectomy after neoadjuvant chemotherapy for malignant pleural mesothelioma
• Main results:
  • In this patient, the right pericardium was removed and rebuilt with a tailored PTFE prosthesis.
  • After surgery, the patient had no symptoms and no problems with his circulation.
  • A routine chest X-ray one hour after surgery unexpectedly showed massive dextrocardia (the heart displaced to the right).
  • At the emergency re-operation, the surgeons found the heart had herniated because the stitches of the pericardial prosthesis had partly come apart.
  • After the prosthesis was re-fixed with new stitches, a repeat X-ray confirmed the heart was back in its correct position, and recovery was uneventful.
• The authors' conclusion: The authors concluded that, although cardiac herniation after extrapleural pneumonectomy is uncommon, thoracic surgeons should always consider it as a possible complication, whether or not the patient has symptoms.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

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

Related studies

• Acute cardiac herniation after radical pleuropneumonectomy — R.J. Self, R.S. Vaughan (1999)
• 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)
• Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? — P. Mordant, K. McRae, et al. (2016)
• Recurrent pericardial effusion with pericardial amyloid deposition: a case report and literature review — H. Itagaki, T. Yamamoto, et al. (2020)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)

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