Cor Vasa 2024, 66(6):615-619 | DOI: 10.33678/cor.2024.086

Intercostal lung hernia as a complication of minithoracotomy for transapical valve implantation - a case report

Štefan Lukačin, Tomáš Toporcer, Anton Bereš, Marián Homola, Michal Trebišovský, Adrián Kolesár

Department of Heart Surgery, East Slovak Institute of Cardiovascular Diseases and Medical Faculty, University of Pavol Jozef Šafárik in Košice, Košice, Slovakia

Intercostal lung herniation is defined as a protrusion of lung tissue beyond the normal limits of the chest wall. The first case of pulmonary hernia was described in 1499 by Roland. The ratio of acquired to congenital lung hernias is 4 : 1. Based on anatomical localisation, cervical, intercostal, and diaphragmatic forms of lung herniation are known. The risk zone for posttraumatic and postoperative intercostal lung hernia is the front wall of the chest due to the poor muscular cover. The case report presents a 71-year-old man who underwent aortocoronary bypass, replacement of the mitral valve, repair of the tricuspid valve, and the MAZE procedure 9 years ago, as well as transapical implantation of the mitral valve through thoracotomy half a year ago. Repeat pleural puncture due to pleural effusion after valve implantation was needed. The pa- tient came to the hospital because of a painful resistance at the site of the thoracotomy scar which increased during the Valsalva manoeuvre. Ultrasonography and computed tomography confirmed the diagnosis of an intercostal lung hernia. A resection of the hernial sac was performed, and the defect was closed by implant- ing a polypropylene mesh. The patient was discharged in a good condition. Transapical valve implantation represents a unique combination of risk factors for the formation of an intercostal lung hernia, both from the patient's side and from the operative approach. Consistent monitoring of patients for the purpose of early identification of the presence of an intercostal lung hernia should be an unconditional part of the postoperative monitoring of patients after transapical valve implantation.

Keywords: Heart surgery, Intercostal lung hernia, Transapical valve implantation

Received: September 30, 2024; Revised: October 9, 2024; Accepted: October 14, 2024; Prepublished online: June 2, 2012; Published: December 20, 2024  Show citation