Cardiac herniation after extrapleural pneumonectomy

Our plain-English summary of Cardiac herniation after extrapleural pneumonectomy, by N. Nishizawa, T. Osaki, Y. Fukuichi, et al (Journal of Surgical Case Reports, 2020).

The study

• Authors: N. Nishizawa, T. Osaki, Y. Fukuichi, M. Yasuda
• Journal: Journal of Surgical Case Reports
• Published: 2020;2020(2):rjaa011
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Cardiac herniation is a fatal complication in patients undergoing pneumonectomy with pericardial resection. A 53-year-old man underwent right-sided extrapleural pneumonectomy for malignant pleural mesothelioma. He underwent right-sided pericardial resection and reconstruction with an expanded polytetrafluoroethylene sheet. Routine chest radiography performed 18 h postoperatively revealed cardiac herniation into the right-sided thoracic cavity. The patient was immediately transferred to the operating room, and the defect was repaired. He died of tumor progression. However, cardiac herniation did not recur over 2 years postoperatively.

Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.

In plain English

This case report from the Department of Chest Surgery at Iizuka Hospital in Japan described a 53-year-old man diagnosed, based on pleural biopsy, with malignant pleural mesothelioma, clinical stage III. The article did not mention asbestos exposure. After two courses of chemotherapy with cisplatin and pemetrexed, he had a right-sided extrapleural pneumonectomy. Part of his pericardium (the sac around the heart) was removed and rebuilt with expanded polytetrafluoroethylene (ePTFE) sheets. Eighteen hours after surgery he felt unwell and had low blood pressure. A routine chest X-ray showed his heart had herniated into the right chest cavity. In an emergency operation, the surgeons found torn stitches on the back of the sheet. They put the heart back and closed the gap with a second ePTFE sheet. He was discharged 43 days later. He died of tumor progression 2 years after the second operation, and the herniation did not recur. The authors concluded that rebuilding the pericardial defect with release of tension at the first operation can prevent this complication.

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 (one patient)
• Who was studied: one 53-year-old man in Japan, treated in the Department of Chest Surgery at Iizuka Hospital, with malignant pleural mesothelioma, clinical stage III (T2 N1 M0)
• Exposure: The article does not mention asbestos or any fiber exposure. It concerns surgery: right-sided extrapleural pneumonectomy with pericardial resection, and pericardial and diaphragmatic reconstruction with ePTFE sheets, after two courses of cisplatin and pemetrexed chemotherapy.
• Main results:
  • At 18 hours after surgery the patient felt unwell and developed hypotension (89/57 mmHg with noradrenaline 0.015 μg/kg/min).
  • Routine chest radiography showed cardiac herniation into the right-sided thoracic cavity.
  • At emergency thoracotomy, the herniation was found to result from tearing of sutures on the posterior aspect of the ePTFE sheet. The defect was repaired with another ePTFE sheet.
  • The patient was discharged 43 days after the second operation. He died of tumor progression 2 years after it, and cardiac herniation did not recur.
• The authors' conclusion: The authors concluded that cardiac herniation after extrapleural pneumonectomy is often fatal, but that reconstruction of the pericardial defect with light release of tension at the initial operation can prevent it. They attributed the suture tearing in this case to high tension of the ePTFE sheet and the interrupted sutures on its posterior aspect.

Topics

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pneumonectomy, Pericardial, Pleural Mesothelioma.

Related studies

• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)
• Cardiac herniation identified without any symptoms following extrapleural pneumonectomy: a case report — R. Tokuda, S. Ikebe, et al. (2025)
• Diaphragmatic Herniation through Prosthetic Material after Extrapleural Pneumonectomy: Be Aware of Tumor Recurrence — D. Pop, C. Cohen, et al. (2013)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Acute postoperative cardiac herniation — K. Kawamukai, F. Antonacci, et al. (2011)
• Acute cardiac herniation after radical pleuropneumonectomy — R.J. Self, R.S. Vaughan (1999)

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