title: Cardiac herniation and lung torsion following heart and lung transplantation.
abstract: A 45-year-old male heart-lung transplant recipient reported reduced exercise tolerance two months post-transplant. Spirometry, right heart pressures, bronchoscopy, trans-bronchial and endomyocardial biopsy were normal. Investigations demonstrated posterior and leftwards herniation of the heart through the posterior pericardial window created during the transplant operation with secondary 90 degrees forward twist of the left lung. This phenomenon generated mild functional narrowing of the left pulmonary artery demonstrable on magnetic resonance imaging. Cardiac herniation with lung torsion is a rare finding post heart-lung transplantation and usually manifests in the early postoperative period with haemodynamic compromise, requiring immediate correction. Our case demonstrates that heart graft herniation and secondary partial lung torsion can occur in the chronic phase without catastrophic consequences.
authors.affiliation: Department of Radiology, University Hospital Birmingham NHS Foundation Trust, Metchley Lane, Edgbaston, Birmingham, B15 2TH, UK. Ben.holloway@uhb.nhs.uk
authors.forename: Benjamin
authors.initials: B
authors.lastname: Holloway
authors.forename: Majid
authors.initials: M
authors.lastname: Mukadam
authors.forename: Richard
authors.initials: R
authors.lastname: Thompson
authors.forename: Robert
authors.initials: R
authors.lastname: Bonser
mesh_terms: D017079:Exercise Tolerance; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016041:Heart-Lung Transplantation / Q000009:adverse effects*; D006439:Hemodynamics; D006547:Hernia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000503:physiopathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology