Cardiac herniation case report: Rare complication after ASD surgery

This Cardiac herniation case study offers a rare look into a life-threatening complication following atrial septal defect (ASD) closure in a pediatric patient. Reported by a team led by Dr. Sajan Koshy, this case emphasizes the need for precise surgical technique, rapid post-operative response, and heightened awareness in congenital heart procedures.

Cardiac herniation is a seldom-seen postoperative emergency, but when it occurs, immediate action is vital. The case study showcases not just a surgical event but also the protocols that saved a young life.

Study Reference & Research Team

Title: Cardiac herniation following closure of atrial septal defect through limited posterior thoracotomy
Authors:

• S. Sasidharan
  
• T. Moideen
  
• K. Warrier
  
• S. Koshy
  
• R. Bastian
  
• K. Unnikrishnan
  
• S. Nair
  

Journal: Interactive Cardiovascular and Thoracic Surgery, 2006
PubMed Link: https://pubmed.ncbi.nlm.nih.gov/17331812/

What Is a Cardiac Herniation Case Study?

A cardiac herniation case study focuses on the displacement of the heart through a pericardial defect—commonly due to incomplete closure or excessive tissue tension post-surgery. Although extremely rare, such displacement can mimic tamponade symptoms and lead to sudden cardiovascular collapse if undiagnosed.

The Patient Case: Real-Time Emergency

An 8-year-old girl underwent ASD closure via a limited right posterior thoracotomy—a minimally invasive method praised for better cosmetic results. Just hours into recovery, she showed classic distress signs: tachycardia, hypotension, and reduced oxygen saturation.

Quick bedside echocardiography revealed cardiac herniation. The surgical team re-entered via the original incision, manually repositioned the heart, and closed the pericardial gap securely.

This cardiac herniation case study illustrates how preparedness and immediate re-intervention can mean the difference between life and death.

Key Learning Points from This Cardiac Herniation Case Study

1. Always Close or Enlarge the Pericardial Defect

In minimally invasive thoracotomies, pericardial openings are inevitable. If not closed or adequately enlarged, the risk of cardiac herniation increases drastically.

2. Recognize Tamponade-like Symptoms Immediately

This cardiac herniation case study revealed that symptoms mimicked cardiac tamponade. ICU teams must suspect herniation if low BP, jugular distension, or hypoxia are present after thoracic procedures.

3. Imaging Saves Lives

Prompt echocardiography or CT scanning is crucial. In this case, echo enabled quick diagnosis, proving imaging is a non-negotiable tool in post-op ICU care.

Surgical Procedure Overview

• Surgical Approach: Limited right posterior thoracotomy
• Bypass Method: Femoral artery and central venous cannulation
• ASD Closure: Direct closure under standard bypass
• Complication Management: Re-operation, heart repositioning, pericardial reinforcement

This reinforces that even small incisions can present big challenges—and the solution often lies in standard protocols done well.

Implications of This Cardiac Herniation Case Study

For Surgeons:

• Reconsider pericardial closure in limited thoracotomies.
• Conduct team reviews on high-risk closure zones.

For ICU Teams:

• Create protocols for early recognition of cardiac herniation signs.
• Train on echo-first response in post-ASD surgery patients.

For Parents and Families:

• Ask about postoperative care monitoring and imaging readiness.
• Ensure the surgical team explains all procedural risks and safety nets.

Expert Perspective from Dr. Sajan Koshy

Dr. Koshy’s team didn’t just manage the emergency—they turned it into a published case study to help other teams globally. The case has since been integrated into pediatric cardiothoracic training modules.

Conclusion

This case study shines a light on the rare but serious risk of pericardial herniation after ASD repair. Thanks to swift teamwork and surgical precision, the patient survived and recovered fully. The case reinforces that excellence in pediatric cardiac care lies in preparation, vigilance, and shared learning.