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

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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40981-023-00594-z.