右肺全摘術後の遅発性心臓部分ヘルニアの1例

Delayed Cardiac Partial Herniation after Right-sided Pneumonectomy：Report of a Case

はじめに　肺全摘後の心臓ヘルニアはまれな合併症である．術後急性期に発症し重篤な病態であることが多く，迅速な診断および治療が必要である．われわれは，右肺全摘後に遅発性に右房のみが心囊外に脱出する心臓ヘルニアの1例を経験したため，文献的考察を加えて報告する．

Cardiac herniation is a rare complication after pulmonary surgery. A 59-year-old woman underwent right-sided pneumonectomy for right pulmonary squamous cell carcinoma, pulmonary vein was ligated intrapericardialy and the pericardial defect, which mesasured about 2 cm was not repaired. After four months, the patient complained of bilateral lower leg edema and dyspnea on effort. Computed tomography （CT） showed the right atrial herniation into the right-sided thoracic cavity. We diagnosed with symptomatic cardiac herniation and performed opration with small thoracotomy. At operation it was found that the right atrium herniated into the right-sided thoracic cavity. There were no adhesions between the pericardium and the right atrium. We placed the right atrium back within the pericardium and repaired using a bovine pericardial patch. The postoperative course was uneventful. Bilateral lower leg edema and cardiac herniation disappeared. Cardiac herniation did not recur over four years postoperatively.