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


CONCLUSIONS
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.
Division of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Elamakkara P.O., Kochi 682026, Kerala, India.
Baiju
B
Sasidharan
Ijaz
I
Moideen
Girish
G
Warrier
Anil
A
Prabhu
Sajan
S
Koshy
Suresh Gangadharan
SG
Nair
Suresh
S
Gururaja Rao
Krishnanaik
K
Shivaprakasha