Transesophageal echocardiography for cardiac herniation occurring during robotic-assisted mitral valve repair: a case report

Kazuto Miyata; Sayaka Shigematsu; Naoki Miyayama

doi:10.1186/s40981-023-00594-z

Transesophageal echocardiography for cardiac herniation occurring during robotic-assisted mitral valve repair: a case report

JA Clin Rep. 2023 Jan 13;9(1):2. doi: 10.1186/s40981-023-00594-z.

Authors

Kazuto Miyata¹, Sayaka Shigematsu², Naoki Miyayama²

Affiliations

¹ Department of Anesthesia, New Heart Watanabe Institute, Hamadayama 3-19-11, Suginami-Ku, Tokyo, Japan. kmiyata0410@gmail.com.
² Department of Anesthesia, New Heart Watanabe Institute, Hamadayama 3-19-11, Suginami-Ku, Tokyo, Japan.

Abstract

Background: Cardiac herniation has been reported in thoracic trauma and after pneumonectomy; however, it is sporadic in cardiac surgery.

Case presentation: A 35-year-old male patient underwent an elective totally endoscopic robotic-assisted mitral valve repair (TERMVR). His hemodynamics were stable after weaning from cardiopulmonary bypass, and no residual mitral valve regurgitation was observed. However, during suturing of the port wound, the patient developed hypotension, which improved with phenylephrine administration. Four-chamber transesophageal echocardiography (TEE) images showed cardiac deformity, and postoperative chest radiography confirmed the dextrocardia. The cardiac herniation was repaired by deflating the left lung and over-inflating the right lung using a double-lumen tube, allowing selective ventilation without re-thoracotomy. The patient was discharged on the sixth postoperative day without complications.

Conclusions: This was a very unusual case of cardiac herniation during TERMVR visualized using distinct TEE images. The cardiac herniation was successfully repaired using a double-lumen tube without re-thoracotomy.

Keywords: Cardiac herniation; Double-lumen tube; Robotic-assisted mitral valve repair; Transesophageal echocardiography.