Two cases of strangulation of the heart following left intrapericardial pneumonectomy are described. The condition presents in the immediate post-operative period by sudden fall of blood pressure associated with a high central venous pressure. The diagnosis is usually made by the characteristic radiographic appearances. Actual strangulation of the ventricles is more common on the left side and can lead to irreversible damage in a short time. The predisposing and precipitating factors are discussed with special reference to prevention. Treatment of the established case is by emergency thoracotomy and reduction of the herniated heart. Recurrence is prevented by repairing the defect or wide excision of the pericardium.
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