Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

We present the case of a 74 year-old symptomatic male with severe aortic valve stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion.Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, unless viscera strangulation and necrosis are suspected. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.Morgagni hernias are very rare in adults accounting for 2-3% of all diaphragmatic hernias [1]. Although obstructive symptoms of the herniated viscera represent the most common clinical presentation there have been rare cases of severe compressive symptoms to the heart [2]. We present the case of a 75 year old male admitted to the hospital because of severe respiratory failure with cardiac tamponade due to a giant foramen of Morgagni hernia complicating an existing severe aortic valve stenosis. The patients underwent to emergency treatment of both problems under cardiopulmonary bypass. To the best of our knowledge this case is the only one reported with combined aortic valve replacement and Morgagni hernia repair.A 75-year-old obese man was admitted to the cardiac intensive care unit with fever (38.2°C), retrosternal pain and progressive dyspnea. The patient had distended jugular veins, paradoxical pulse wheezes and bowel sounds at the left hemithorax during auscultation. At the time of admission the electrocardiogram showed signs of left ventricular hypertrophy. Chest x-rays was remarkable for widening of the mediastinum compatible with the presence of vi