Department of Anesthesiology/Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
J Anesth. 2010 Dec;24(6):926-9. doi: 10.1007/s00540-010-1007-1. Epub 2010 Aug 25.
A 44-year-old man underwent radical thymectomy for malignant thymoma 5 years ago. He subsequently underwent right extrapleural pneumonectomy because a right pleural metastatic lesion had developed. The operation was completed uneventfully. Immediately after arrival at the intensive care unit, the patient appeared restless and in pain. His heart rate increased to 140 bpm and then abruptly decreased to 20-30 bpm concomitant with profound systolic hypotension of 30-40 mmHg. Chest X-ray showed that the heart was shifted into the right thorax. Emergent re-thoracotomy was performed and the heart was found to be malrotated and herniated from an upper defect of the pericardial patch in the right thoracic cavity. The heart was returned to the pericardium and the defect was covered with a pericardial patch. The blood pressure and heart rate became stable. He was transferred to the surgical ward from the intensive care unit on the first postoperative day. The rest of the course was uneventful and the patient was discharged on the seventh postoperative day. The incidence of cardiac herniation after extrapleural pneumonectomy following chemotherapy for malignant pleural mesothelioma has been reported to be around 3%. The risk of cardiac herniation should always be considered, especially after extrapleural pneumonectomy.
一位 44 岁男性，5 年前因恶性胸腺瘤接受了根治性胸腺切除术。此后，因右侧胸膜转移病灶发展而行右侧胸膜外肺切除术。手术顺利完成。患者一到达重症监护病房，就显得烦躁不安和疼痛。他的心率增加到 140 bpm，然后突然下降到 20-30 bpm，同时出现严重的收缩压低至 30-40 mmHg。胸部 X 线显示心脏已转移到右侧胸腔。紧急再次开胸，发现心脏旋转不良，并从右侧胸腔心包补片的上部缺陷疝出。心脏被送回心包，并用心包补片覆盖缺陷。血压和心率变得稳定。他于术后第一天从重症监护病房转至外科病房。术后其余过程顺利，患者于术后第 7 天出院。恶性胸膜间皮瘤化疗后胸膜外肺切除术后心脏疝的发生率约为 3%。应始终考虑心脏疝的风险，尤其是在胸膜外肺切除术后。
