Acute Cardiac Herniation after Right Pleuropneumonectomy (Case Report and Review of Literature)

Abstract

Extra-pleural pneumonectomy (EPP) is an extensive surgery for management of pleural mesothelioma that is associated with perioperative morbidity of 60-63%. Extrapleural pneumonectomy (EPP) or pleuropneumonectomy for diffuse malignant pleural mesothelioma is a radical surgery which includes en bloc resection of the pleura, lung, ipsilateral hemidiaphragm and anterior pericardium. Acute cardiac herniation an extremely rare post-operative complication can cause immediate mortality in more than 50% of cases. Prevention and early recognition and management are necessary for favorable outcome. We report here the case of fatal acute cardiac herniation following right pleuropneumonectomy that caused sudden circulatory collapse upon patient manupalation shortly after admission. The patient died after futile cardiopulmonary resuscitation while preparing for emergency cardiothoracic surgery. Prevention of acute cardiac herniation by adequate closure of the pericardial defect, avoiding excessive manupalation of the patient and Early recognition and management by emergency cardiothoracic surgery can leads to better outcome.