Cardiac herniation after right sleeve pneumonectomy with partial pericardiectomy

: A 63-year-old male underwent a sleeve pneumonectomy with partial pericardiectomy for a squamous cell carcinoma of the right upper bronchus invading the trachea. The pericardial defect was closed primarily. The initial postoperative course was uneventful until we performed endotracheal suction with bronchoscopy in that evening. After severe coughing, he was noted to have a decrease in blood pressure following bradycardia and premature ventricular contraction. He soon fell in shock. A chest X-ray film revealed the cardiac shadow shifted to the right hemithorax. Immediately he was taken back to the theater and rethoracotomy was performed. The heart was found to have herniated into the right hemithorax. As soon as it was repositioned, his general condition improved. The pericardial defect was repaired with a GORE-TEX patch. He recovered. The cardiac herniation after pneumonectomy is one of the fatal complications unless prompt diagnosis and surgical reduction should be done. Repair of the pericardial defect with strong prosthetic patches and careful postoperative management are indispensable for the prevention of the cardiac herniation after pneumonectomy.