Cardiac luxation in ICU after coughing effort following right pneumonectomy

Excerpt

A 75-year-old-man was admitted to our department for the management of a right lung squamous cell carcinoma invading the hilum. His medical history revealed COPD without surgical contra-indication. A right pneumonectomy was performed by means of a 5th space postero lateral thoracotomy. A partial pericardectomy was necessary close to the origin of the superior vena cava and the right atrium with right phrenic nerve preservation. The closure of the pericardectomy was performed using stitches of 2.0 polypropylene sutures. After 1 day in the ICU and secondary to violent coughing efforts, the patient presented hemodynamic instability with severe hypotension and tachycardia. After fluid rehabilitation and vasoactive perfusion of sympathomimetic amine, the patient had standard chest X-ray (Fig. 1) and thoracic CT-scan (Fig. 2) showing a cardiac luxation in the right chest cavity. The patient was immediately transferred to the operating room where a second thoracotomy was performed showing complete cardiac luxation. The heart was immediately reintroduced into the pericardium revealing a complete pericardium rupture until the inferior vena cava. The pericardium closure was realized using an equine pericardial patch stitched by 2.0 polypropylene sutures. After 1 year, the patient is still alive without cancer relapse.

…