Heart-Lung Herniation After Left Thoracotomy

Abstract

SESSION TITLE: Global Case Report Poster - Cardiothoracic Surgery SESSION TYPE: Global Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Heart - Lung herniation is a rare clinical event; it is unusual to see both heart and lung herniated through chest wall defect. Most of the causes are traumatic. We reported a case of Heart - Lung herniation after left thoracotomy for CABG operation CASE PRESENTATION: 59 year female patient with history of hypertension, insulin dependent DM, dyslipidemia and Coronary artery disease with previous coronary angiography, underwent CABG with left thoracotomy technique. Patient was discharged to ICU on IABP, adrenaline and dopamine infusion because of refectory hypotension and bradycardia. Chest x ray showed left lung collapse and picture of left side pleural effusion, there was no drainage from chest tube. For 3 dayspost-op, ECG showed new ischemic changes. CT chest was done and showed dehiscence of the left thoracotomy and bulging of the cardiac shadow and part of the lingular segment through the defect. Surgical repair with correction of the position of the heart and lung with suturing of intercostal muscles to prevent re∖re herniation. Patient was weaned off off IABP and inotropes. DISCUSSION: Heart - lung herniation after thoracic surgery is a rare complication, few cases had been reported for lung or heart herniation, Most of cardiac herniations are caused following blunt trauma producing rupture of the pericardium. Lung hernias have also been described as a result of tumors, chest-wall abscess, or invasion from tuberculosis. Diagnosis is made with chest radiograph or CT. Cardiopulmary compromise is the most serious complications which may include cardiogenic shock, and picture of cardiac tamponad, which can cause systemic hypoperfusion and increase inotropic, and pressores requirement, and delay the weaning from MV post operatively. Conservative management is an option in stable patient's, however, surgical repair should be instituted. In unstable patients. CONCLUSIONS: Chest imaging Order view is of paramount importance operatively, especially with hemodynamic instability that is refractory to inotropic and vasopressor support. Diagnosis can be made by CXR but in this case it was diagnosed accidently by doing CT chest. Early diagnosis is required to prevent further deterioration. Surgical repair in unstable patients should be pursued. Reference #1: 1-Sasidharan et al. / Cardiac herniation following closure of atrial septal defect through limited posterior thoracotomy, Interactive CardioVascular and Thoracic Surgery 5 (2006) 272-274. Reference #2: John S Emberger et al. / Lung Hernia Associated With Hemothorax Following Cardiopulmonary Resuscitation, Respir Care 2011;56(7):1037-1039. DISCLOSURE: The following authors have nothing to disclose: Islam Ibrahim, Mahmoud Abdullah, Ahmed Abdelsalam, Mohamed Badawy No Product/Research Disclosure Information