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(Circulation. 2002;105:e49.)
© 2002 American Heart Association, Inc.

Circulation Electronic Pages

Postoperative Dislocation of the Heart After Pneumonectomy

Jens Rodenwaldt, MD; Alexander E. Lembcke, MD; Till H. Wiese, MD; Sebastian Höhn; Bernd K. Hamm, MD

From the Department of Radiology, Humboldt-University of Berlin, Germany.

Correspondence to Jens Rodenwaldt, MD, Dept of Radiology, Humboldt-University of Berlin, Campus Charité Mitte, Schumannstraße 20/21, 10117 Berlin, Germany. E-mail jens.rodenwaldt@charite.de

A 48-year-old patient with bronchial cancer of the right upper pulmonary lobe confirmed by bronchoscopy and biopsy underwent extended pneumonectomy with partial pericardial resection and intrapericardial severing of the pulmonary vessels. On the third postoperative day, surgical revision was required for extensive thoracic bleeding. A sudden deterioration of the patient’s condition occurred a few hours after the second intervention. Clinically, there was a dramatic drop in arterial blood pressure along with tachycardia. The patient developed a superior vena cava syndrome with an increase in central venous pressure associated with cyanosis of the upper part of the body. Chest X-ray demonstrated displacement of the heart into the pneumonectomy cavity combined with a rightward rotation of the heart axis (Figure 2A). On the way to the operating room for emergency rethoracotomy, a contrast-enhanced multidetector computed tomography (CT) was performed, which confirmed displacement of the heart (Figure 1). The heart was dislocated from the residual pericardial sac and rotated rightwards by approximately 150° about the axis of the superior and inferior vena cava, resulting in nearly complete occlusion of venous reflux into the right atrium (Figure 2B). The patient died despite immediate surgical repositioning of the heart.

View larger version (110K): [in this window] [in a new window]   Figure 2. Postoperative displacement of the heart toward the right. A, Demonstration by radiography. B, Three-dimensional volume-rendered reconstruction of the multislice CT source data.

View larger version (94K): [in this window] [in a new window]   Figure 1. Multislice CT showing displacement of the heart. A, Displacement of the heart into the pneumonectomy cavity and axial rotation. B, Torsion of the inferior . . . [Full Text of this Article]