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Unexpected Postoperative Course After Right Pneumonectomy*

Carlos A. Montero, MD; Josep M. Gimferrer, MD; Guillermina Fita, MD; Mireia Serra, MD; Miguel Catalán, MD; Emilio Canalís, MD, FCCP
Author and Funding Information

*From the Departments of Thoracic Surgery (Drs. Montero, Gimferrer, Serra, Catalán, and Canalís) and Anesthesiology (Dr. Fita), Hospital Clínic, Universitat de Barcelona, Spain.

Correspondence to: Carlos A. Montero, MD, Department of Thoracic Surgery, Hospital Clinic, Universitat de Barcelona, 170 Villarroel St, 08036 Barcelona, Spain; e-mail: montero@medicina.ub.es



Chest. 2000;117(4):1184-1185. doi:10.1378/chest.117.4.1184
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Extract

A 58 -year-old male patient with noncomplicated alcoholic liver disease presented with a right upper parahilar pulmonary mass after minor blunt chest trauma. After an appropriate workup, non-small cell carcinoma of the lung was diagnosed. A right intrapericardial pneumonectomy was performed. A silastic chest drain with no negative pressure was left connected to a compensatory postpneumonectomy system. The patient was extubated 30 min after the operation. A few minutes later while in the recovery room, the patient developed atrial fibrillation with fast heart rate of 150 beats/min. Digoxin and amiodarone were started. Shortly thereafter, ventricular fibrillation required a 300-J/s direct current shock. The patient was intubated again, and cardiopulmonary resuscitation was performed. Complete atrioventricular block developed, and a percutaneous transjugular right ventricular pacing lead was inserted. A chest radiograph demonstrated mediastinal shift toward the pneumonectomy side (Fig 1) .

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