Cardiac herniation following intrapericardial pneumonectomy.

Cardiac herniation is a rare, highly lethal complication of intrapericardial pneumonectomy, demanding urgent treatment. The condition presents in the immediate or early postoperative period. Cardiovascular collapse is invariably present. Elevation of the jugular venous pressure and cyanosis in the drainage area of the superior vena cava are frequently noted. Diagnosis rests on an awareness of this condition, its clinical manifestation, and radiological examination. This paper reports three patients who developed cardiac herniation following intrapericardial pneumonectomy, in two of whom massive haemorrhage complicated the herniation. A tear at the left aspect of the inferior atriocaval junction occurred as a result of cardiac herniation into the right pleural cavity in one case, and in the other the apex of the left ventricle was perforated by a fractured rib following a left pneumonectomy. A survey of the literature has not revealed similar cases. The predisposing factors and methods of prevention and treatment are discussed and previously reported cases are reviewed.