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Cardiac herniation following closure of atrial septal defect through limited posterior thoracotomy

^a Division of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Elamakkara P.O., Kochi 682026, Kerala, India
^b Division of Cardiac Anesthesiology, Amrita Institute of Medical Sciences, Elamakkara P.O., Kochi 682026, Kerala, India

*Corresponding author. Tel.: +91-484-2802005; fax:+91-484-2802020.

E-mail address: shivaprakashak{at}aimshospital.org (K. Shivaprakasha).

Objective: We report an unusual complication following closure of atrial septal defect through right limited posterior thoracotomy. Methods: An eight-year-old girl underwent closure of atrial septal defect through right limited posterior thoracotomy. She developed cardiac herniation in the early post-operative period following a tension pneumothorax on the left side, while recovering in the intensive care unit. Results: Cardiac herniation was promptly recognized, albeit subtle hemodynamic changes, and was reduced through re-operation. Conclusion: Liberal use of pericardium for closure of intra-cardiac defects results in a gap in the pericardial sac. Posterior thoracotomy approach for closure of atrial septal defect has a higher propensity for cardiac herniation owing to the small size and postero-lateral location of the pericardial defect. Recognition and early treatment of cardiac herniation is important since it can mimic cardiac tamponade. Cardiac herniation can be avoided either by enlarging the pericardial defect or by closing it with a prosthetic patch.

Key Words: Congenital-acyanotic; Atrial septal defect; Pericardium; Thoracotomy

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