A case of acute right coronary artery occlusion with cardiac herniation following right pneumonectomy.

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  • 右肺全摘後心臓脱により冠動脈閉塞を引き起こしたと考えられる１救命例

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A patient is described in whom a right -sided cardiac herniation occurred through a pericardial defect following right radical pneumonectomy. A 64-year-old man was referred to our institute in 1997 because of dry cough and low grade fever. An intrapericardial right pneumonectomy for a moderately differentiated squamous cell carcinoma was performed. The pericardial defect was closed directly with interrupted sutures. Postoperative course was stable and no clinical symptoms were noted, but 15 hours after the operation, cardiac herniation occurred suddenly with hypotension, arrhythmia and cardiac arrest. Chest X-ray revealed cardiac herniation into the right hemithorax and was repaired with a Marlex-mesh patch immediately. Electrocardiogram and 20iT1 myocardial scintigram revealed inferior myocardial infarction caused by right coronary artery torsion. Cardiac herniation after pneumonectomy is a fatal complications. In our patient, immediate thoracotomy before irreversible myocardial damage resulted in a successful outcome.

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