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Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado

2017, Number 2

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Rev Esp Med Quir 2017; 22 (2)

Valvular heart disease, ischemia and intrathoracic goiter: Approach in a surgical time

Aceves JL, Gurrola H, Luna JA, Quero F, Rodríguez NJ, Maldonado R, Vilchis R, Poveda V, Yañez B, García L

Language: Spanish
References: 17
Page: 76-80
PDF size: 950.96 Kb.


ABSTRACT

Valvular and ischemic heart disease with intrathoracic goiter is a rare combination. The surgical approach in two times is controversial, because the morbidity and mortality have risk increased in each surgery; so, simultaneous approach in the same surgical time is a reasonable strategy. We present the combined approach of two types of heart disease with intrathoracic goiter in a 66 years old male patient with a history of type 2 diabetes mellitus (T2DM) and systemic arterial hypertension (HT). He started his clinical condition with paroxysmal tachycardia of 1 year evolution, adding small efforts dyspnea in last 30 days. Laboratory and imaging studies showed subclinical hyperthyroidism, widening of the upper mediastinum, tracheal deviation, cardiomegaly III, eccentric left ventricular hypertrophy, aorta indexed area 0.3 cm/m2 with transvalvular gradient of 83 mmHg, left ventricular ejection fraction (LVEF) 35% and stenosis of 80% in OM coronary. Computed tomography (CT) showed tumor of 9.21 x 5.62 x 2.94 cm in anterior neck extending to middle and posterior mediastinum. Thyroid scintigraphy showed multinodular goiter in right lobe. The surgical approach began with thyroidectomy and subsequent bypass with saphenous vein to OM coronary artery and aortic valve replacement with a mechanical prosthesis Carbomedics® No. 21. Noradrenaline (0.04 μg/kg/min) and ventilator support were removed at 12 and 48 postsurgical hours. Hospital stay was 6 days. Conclusion: The simultaneous surgical approach of intrathoracic goiter, aortic valvular and ischemic heart disease is a reasonable and workable procedure.


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