Thoracoscopy: new method of early diagnosis of cardiac herniation.

Cardiac herniation is an uncommon but rapidly fatal complication of radical pneumonectomy. Although operative correction is simple, a successful clinical outcome requires early diagnosis and thoracotomy. A patient is described in whom a left-sided cardiac herniation through a pericardial defect occurred following radical pneumonectomy. The diagnosis was suspected by persistent hypotension and radiographic changes. Confirmation of the diagnosis was achieved by thoracoscopy, performed with local anesthesia in the operating room. Immediate thoracotomy resulted in a successful outcome.