Hazards of Chest Tubes after Pneumonectomy

To the Editor:

The case report of a patient with displacement of the heart into the right pleural space following pneumonectomy, ¹ which appeared in last year's Texas Heart Institute Journal, is accompanied by a chest x-ray showing not only the abnormal cardiac position, but also a chest tube.

Chest tubes are contraindicated after pneumonectomy for just the reason described in the case report: suction on the tube may cause displacement of the heart or mediastinum into the pleural space, with consequent circulatory dysfunction. In addition, it is likely that the track may serve as a conduit for the introduction of bacteria and contribute to an increased incidence of post-pneumonectomy empyema.

Although the authors of the article comment, correctly, on the importance of pericardial defects in post-pneumonectomy complications such as cardiac dislocation, they make no comment about the chest tube. Even without a pericardial defect such as the one that occurred in the patient described here, chest tubes have no place in the routine management of a patient after uncomplicated pneumonectomy.