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Cardiac Herniation Through a Pericardial Defect After Minimally Invasive Mitral Valve Surgery

Mamoun, Negmeldeen F. MD, PhD*; Koch, Colleen G. MD, MS*; Gillinov, A. Marc MD

doi: 10.1097/ACC.0b013e31829c685d
Case Reports: Case Report

Minimally invasive mitral valve surgery has been increasingly performed because of its presumed advantages over traditional surgery performed through median sternotomy. Cardiac herniation is an extremely rare complication initially reported by Bettman and Tannenbaum in 1948. It is usually reported after blunt chest trauma or pneumonectomy, but can potentially occur after any minimally invasive surgery involving a pericardial incision. In this case report, we present 2 cases of cardiac herniation occurring after minimally invasive mitral valve surgery; the 2 cases had different surgical exposures and clinical presentations. Early diagnosis is crucial for a timely lifesaving definitive management.

From the Departments of *Cardiothoracic Anesthesiology and Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.

Accepted for publication April 25, 2013.

Funding: Not applicable.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site. (

Address correspondence to Negmeldeen F. Mamoun, MD, PhD, Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Ave./J4-331, Cleveland, OH 44195. Address e-mail to

© 2013 International Anesthesia Research Society
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