Floating chest syndrome after minimally invasive thoracotomy: pathogenesis, diagnosis, prevention, and treatment

Kosovan D.M.

Main
Publications
Floating chest syndrome after minimally invasive thoracotomy: pathogenesis, diagnosis, prevention, and treatment

March 27, 2025

137

Surgery

Kosovan D.M.

УДК: 616.12-089.844:617.542-089.168-06

DOI: 10.32471/umj.1680-3051.264324

Keywords :

chest wall instability,

floating chest syndrome,

minimally invasive thoracotomy

Specialities :

Surgery

Resume

The article reviews the pathogenesis, diagnostics, prevention and treatment of floating chest syndrome (FTS) as a complication after minimally invasive mitral valve surgery via right-sided thoracotomy. Attention is paid to the analysis of risk factors, mechanisms of intercostal defects development, effectiveness of modern methods of prevention and assessment of optimal treatment tactics. Literature sources for the last 5 years were analyzed, clinical cases were retrospectively evaluated, instrumental diagnostic methods (computed tomography, radiography, ultrasound) were used and various methods of prevention and treatment were compared. It was established that the main risk factors for the development of FTS are insufficient suturing of the intercostal space, osteoporosis, chronic obstructive pulmonary disease and postoperative cough. Diagnosis is based on computed tomography with Valsalva maneuver, which allows to detect intercostal defects. The most effective treatment method is chest wall reconstruction using mesh implants, and the videothoracoscopic approach provides faster rehabilitation. Prevention of FGS should include gentle surgical technique and reliable intercostal suturing. In the event of the syndrome developing, timely surgical treatment minimizes risks and improves the quality of life of patients.

References

1. Reser D., Holubec T., Yilmaz M. et al. (2015) Right lateral mini-thoracotomy for mitral valve surgery. Multimed Man Cardiothorac Surg. (1): mmv031.
2. Weiser Th.G. (2024) Flail chest. http://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/flail-chest.
3. D’Ambrosio P.D., Silva H.F., Mariani A.W. et al. (2023) Post-thoracotomy lung hernia: case report. J. Bras. Pneumol., 49(1): e20220325.
4. Vinck E.E., Zapata R.A., Tarazona C.A. et al. (2024) Intercostal Lung Hernias Presenting After Minimally Invasive Cardiac Surgery. Braz. J. Cardiovasc. Surg., 39(5): e20230403. doi: 10.21470/1678-9741-2023-0403.
5. Varona Porres D., Pallisa E., Sánchez A.L., Persiva O. (2019) Usefulness of Thoracic Ultrasound in the Diagnosis of Intercostal Pulmonary Hernias. Arch. Bronconeumol. (Engl. Ed.), 55(4): 225–226. English, Spanish. doi: 10.1016/j.arbres.2018.06.020.
6. Athanassiadi K., Bagaev E., Simon A., Haverich A. (2008) Lung herniation: a rare complication in minimally invasive cardiothoracic surgery. Eur. J. Cardiothorac. Surg., 33(5): 774–776. doi: 10.1016/j.ejcts.2008.01.027.
7. Cetinkaya A., Zeriouh M., Liakopoulos O.J. et al. (2020) Pulmonary herniation after minimally invasive cardiac surgery: review and implications from a series of 20 cases. J. Surg. Case Rep., 2020(11): rjaa415. doi: 10.1093/jscr/rjaa415.
8. Schroeter T., Bittner H., Subramanian S. et al. (2011) Life-threatening hemothorax resulting from lung hernia after minimally invasive mitral valve surgery. Thorac. Cardiovasc. Surg., 59(4): 252–254. doi: 10.1055/s-0030-1250670.
9. Wheeler M. (2015) Intercostal lung herniation. doi.org/10.53347/rID-40441.
10. Detorakis E.E., Androulidakis E. (2014) Intercostal lung herniation — the role of imaging. J. Radiol. Case Rep., 8(4): 16–24. doi: 10.3941/jrcr.v8i4.1606.
11. Koichi Y., Ise H., Ohira S. et al. (2019) Manual repositioning of lung hernia after minimally invasive cardiac surgery. J. Surg. Case Rep., 2019(3): rjz056.
12. Kruse J., Silaschi M., Velten M. et al. (2023) Femoral or Axillary Cannulation for Extracorporeal Circulation during Minimally Invasive Heart Valve Surgery (FAMI): Protocol for a Multi-Center Prospective Randomized Trial. J. Clin. Med., 12(16): 5344.
13. Ahmad A.M. (2018) Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know. A Narrative Review. Korean J. Thorac. Cardiovasc. Surg., 51(5): 293–307. doi: 10.5090/kjtcs.2018.51.5.293.
14. Teichman M., Javidan-Nejad C., Chung, J. (2023) Lung herniation following blunt thoracic trauma. ACS Case Reviews in Surgery, 3(2).
15. Chiang T.Y., Yin M.F., Yang S.M., Chen K.C. (2017) Thoracoscopic management of incarcerated lung herniation after blunt chest trauma: a case report and literature review. J. Thorac. Dis., 9(3): E253–E257. doi: 10.21037/jtd.2017.03.41.
16. Subotic D., Wiese M., Hojski A., Lardinois D. (2019) Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique. Case Rep. Surg., 2019: 2107083.
17. Jiménez M.F., Colmenares O., Gómez- Hernández M.T. (2024) Biological mesh in chest wall reconstruction: state-of-the-art and our institutional experience. Shanghai Chest, 8: 15.