Life-threatening hemothorax resulting from lung hernia after minimally invasive mitral valve surgery
Introduction: Lung hernias occur uncommonly, with over 80% occuring as result of thoracic trauma, either observed spontaneously or accompanying other pathology. Lung hernia following minimally invasive mitral valve surgery is a uncommen entity. Insufficient healing of the tissues in the intercostal space after minimally invasive valve surgery can result in the development of lung hernia, which partially covered by a pleural sac. We report the case of a male patient who developed a lung hernia as a sequela to limited access mitral valve surgery.
Aims: Two months after discharge, the patient presented with a a bulge in the region of the lateral thoracotomy related to respiration which could be provoked by a Valsalva maneuver. In the night following admission the patient had an acute cardiovascular decompensation with worsening dyspnea, pallor and hypotension. The patient was quickly transferred to the ICU, where a chest x-ray revealed evidence of a large hemothorax with compression of the entire right lung. We transferred the patient to the operation room, evacuate the hemothorax and reconstruct the 15cm long and 3cm wide dehiscence. Due to the size of the defect, a GoreTex patch was used. 2–0 Prolene U-stiches were passed into the chest circumferentially around the defect, extending to one intercostal space above and below the defect. Next, these stiches were passed through the patch, anchoring it intrapleurally.
Discussion: The case illustrates clearly that lung hernia can result in life-threatening complications. In order to avoid complications, attention must be paid to performing a clean, layered closure of the thoracotomyincision during the initial operation. In case of rib fractures, it may be necessary to resect a portion of the ribs, to consider performing an intrapleural coverage of the defect with GoreTex, mesh or a periostal flap during the initial operation.