Cardiac herniation after surgically induced pericardial defects: A systematic review

Cardiac herniation is a rare but potentially fatal complication following thoracic or cardiovascular procedures involving pericardial defects. We systematically reviewed 29 reported cases to evaluate causes, presentations, and outcomes. Most occurred after right intrapericardial pneumonectomy, though mediastinal tumour resections, transplantation, and trauma were also implicated. Clinical features included hypotension, superior vena cava syndrome, and cardiac arrest. Diagnosis was achieved by radiography, computed tomography, or echocardiography. Emergent re-thoracotomy with cardiac repositioning and pericardial repair was essential for survival, while delayed recognition was often fatal. Vigilant monitoring and preventive pericardial reinforcement are recommended.