Cardiac torsion after excision of a huge mature cystic teratoma

3^rd Global Experts Meeting on Medical Case Reports

May 09-10, 2016 New Orleans, USA

Kathleen S Cruz and Jaime Esquivel

Philippine General Hospital, Philippines

Posters & Accepted Abstracts: J Clin Case Rep

Abstract :

Cardiac torsion is a rare complication following pericardiectomy but has a high mortality rate, reported at 30 to 64% in some case reports. Cardiac herniation has been noted in some literature after a pneumonectomy with partial pericardiectomy. There are no case reports on cardiac torsion after excision of a teratoma. This is a case of J.F., 52 year old female with a 12 year history of a progressively enlarging mediastinal cyst. Computed tomographic scan made a few months prior to admission showed a 15Ã?Â?10Ã?Â?20 cm mediastinal cyst displacing the trachea and the heart to the left hemithorax. She underwent median sternotomy with excision of the cyst and en bloc partial pericardiectomy. Intraoperatively, the cyst was 20Ã?Â?20 cm with thick, calcified wall and adherent but not invading the middle and lower lung lobes and the diaphragm. The middle and lower lobes were collapse and non-expanding. Patient had episodes of hypotension postoperatively but was corrected after blood transfusion. Chest radiograph was done immediately after the operation, which showed lower lobe opacity on the right. On physical examination, she had edematous bilateral upper extremities and face. On the third postoperative day, the patient became hypotensive requiring inotropic support. Hypotension was persistent despite fluid resuscitation and with maximum inotropic requirements. Repeat chest radiograph revealed the apex of the heart located at the right chest. Confirmatory echocardiography showed cardiac torsion. She was immediately brought to the operating room for emergency sternotomy and repositioning of the heart. Intraoperatively, the heart herniated out the pericardial space. The cardiac apex was shifted to the right. Repositioning was done and the pericardium was reconstructed using a felt to hold the heart in place. Patient, however, arrested during sternal closure and succumbed to severe metabolic acidosis.

Biography :

Email: kathcruz@gmail.com