Herniation of the heart after intrapericardial pneumonectomy for bronchial carcinoma.

Since the pioneer work of Graham and Singer (1933), Rienhoff (1933), and Crafoord (1938), great improvements have been made in the surgical technique for resection of bronchial carcinoma. Of major importance was the introduction by Allison (1946) of intrapericardial ligation of the pulmonary vessels. Besides inherent advantages due to the intrapericardial disposition of these vessels and consequent ease of dissection (Healey and Gibbon, 1950), the procedure allows a more radical excision of malignant tissue. It does not lead to cardiac incapacity, and the vessel walls inside the pericardium are muscular and tolerate ligation well (Bailey, Tropea, and Rubenstein, 1947). A lower mortality and longer time of survival have been reported when this procedure is used as a routine in radical pneumonectomy compared with extrapericardial simple pneumonectomy (Brock and Whytehead, 1955). Among the complications especially attributable to an intrapericardial pneumonectomy are cardiac arrhythmias and herniation of the heart (Bettman and Tannenbaum, 1948; Higginson, 1953). Two cases of herniation of the heart have been encountered during recent months at the North Middlesex Hospital and are reported here.