Key result
TEE and selective ventilation enable successful reduction of cardiac herniation without re-thoracotomy.
Why the study?
Cardiac herniation is a rare complication in cardiac surgery, with limited reports on its diagnosis and management during robotic-assisted mitral valve repair.
Case Report (n=1)
No
TEE is valuable for diagnosing rare cardiac herniation during robotic-assisted mitral valve repair, which can be managed without re-thoracotomy using selective ventilation.
Cardiac herniation can occur after robotic mitral repair; leaves open questions on incidence, risk factors, and prevention in minimally invasive surgery.
BACKGROUND: Cardiac herniation has been reported in thoracic trauma and after pneumonectomy; however, it is sporadic in cardiac surgery. CASE PRESENTATION: A 35-year-old male patient underwent an elective totally endoscopic robotic-assisted mitral valve repair (TERMVR). His hemodynamics were stable after weaning from cardiopulmonary bypass, and no residual mitral valve regurgitation was observed. However, during suturing of the port wound, the patient developed hypotension, which improved with phenylephrine administration. Four-chamber transesophageal echocardiography (TEE) images showed cardiac deformity, and postoperative chest radiography confirmed the dextrocardia. The cardiac herniation was repaired by deflating the left lung and over-inflating the right lung using a double-lumen tube, allowing selective ventilation without re-thoracotomy. The patient was discharged on the sixth postoperative day without complications. CONCLUSIONS: This was a very unusual case of cardiac herniation during TERMVR visualized using distinct TEE images. The cardiac herniation was successfully repaired using a double-lumen tube without re-thoracotomy.
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Miyata et al. (2023) conducted a case report in Cardiac herniation during robotic-assisted mitral valve repair (n=1). Double-lumen tube ventilation for selective lung inflation/deflation was evaluated on Resolution of cardiac herniation. Cardiac herniation during robotic-assisted mitral valve repair was successfully visualized using transesophageal echocardiography and repaired using a double-lumen tube without re-thoracotomy.
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