İlker İSKENDER, Aysun Kosif MISIRLIOĞLU, Ali ATASALİHİ, Levent ALPAY, Altan KIR

Sağ perikardiyal pnömonektomi sonrası gelişen akut kardiyak herniasyon

Kardiyak herniasyon intraperikardiyal pnömonektominin nadir görülen bir komplikasyonudur ve yüksek mortalite ile seyreder. Otuz üç yaşında erkek hastaya malign invaziv timoma nedeniyle tümör eksizyonuyla birlikte perikardiyopnömonektomi yapıldı. Ameliyat sonrası erken dönemde hipoksi ve hipotansiyon bulguları ile klinik ve radyografik olarak kardiyak herniasyon tanısı kondu. Hasta acil şartlarda revizyona alınarak, kalp repoze edildi ve perikardiyal defekt politetrafloroetilen (PTFE) greft ile kapatıldı. Revizyon sonrası çekilen akciğer grafisinde kalbin eski pozisyonuna geldiği görüldü.

Acute cardiac herniation following right pericardial pneumonectomy

Cardiac herniation is a rare complication of intrapericardial pneumonectomy and has a high mortality rate. A 33-yearold male patient underwent pericardial pneumonectomy together with excision of a malignant invasive thymoma. Cardiac herniation was diagnosed by clinical and radiographic manifestations of hypoxia and hypotension in the early postoperative period. An emergency revision operation was performed, during which the heart was repositioned and the pericardial defect was repaired with a polytetrafluoroethylene (PTFE) graft. A chest x-ray obtained after revision showed normal position of the heart.

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1) Zandberg FT, Verbeke SJ, Snijder RJ, Dalinghaus WH, Roeffel SM, Van Swieten HA. Sudden cardiac herniation 6 months after right pneumonectomy. Ann Thorac Surg 2004; 78:1095-7.
2) Self RJ, Vaughan RS. Acute cardiac herniation after radical pleuropneumonectomy. Anaesthesia 1999;54:564-6.
3) Buniva P, Aluffi A, Rescigno G, Rademacher J, Nazari S. Cardiac herniation and torsion after partial pericardiectomy during right pneumonectomy. Tex Heart Inst J 2001;28:73.
4) Montero CA, Gimferrer JM, Fita G, Serra M, Catalan M, Canalis E. Unexpected postoperative course after right pneumonectomy. Chest 2000;117:1184-5.
5) Ohri SK, Siddiqui AA, Townsend ER. Cardiac torsion after lobectomy with partial pericardectomy. Ann Thorac Surg 1992;53:703-5.
6) Ponn RB. Complications of pulmonary resection. In: Shields TW, editor. General thoracic surgery. Vol. 1, 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 554-86.