Cardiac herniation after intrapericardial right pneumonectomy for bronchial carcinoma.
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概要
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A 61-year-old-man was admitted to our hospital because of a productive cough for one month. Bronchoscopy disclosed a finely granular squamous cell carcinoma in the right upper bronchus. The tumor invaded the right main bronchus and trachea.<BR>Intrapericardial right pneumonectomy with tracheal wedge resection was performed. Direct pericardial closure was performed, but a pericardial defect, 2×2 cm, remained. On the day after operation, cardiac herniation occurred suddenly after severe coughing. Tachycardia, hypotension, cyanosis, and dilatation of the jugular vein were noted. The electrocardiogram showed atrial fibrillation and R waves at V<SUB>3R</SUB> and V<SUB>4R</SUB>. A chest X-ray film revealed a shift of the heart to the right thorax. The right chest was opened immediately, and the heart was found to have rotated 90 degrees to the right. The heart was returned to its normal position, and the general condition improved immediately. The pericardial defect was repaired with a sheet of PTFE. Repair of the pericardial defect with synthetic material shoud be done in order to prevent cardiac herniation following the intrapericardial pneumonectomy.
- 特定非営利活動法人 日本呼吸器外科学会の論文