241 Retrosternal Goitre Resection with Concomitant Mitral Valve Replacement and Tricuspid Repair: An Example of Multi-Specialty Surgical Care

Résumé fourni par la source

Abstract Large retrosternal goitres pose a serious surgical challenge, on occasion requiring multi-specialty care. Retrosternal goitres are traditionally managed through a transcervical and/or sternotomy approach, performed in most incidences by otolaryngologists with occasional assistance from thoracic surgeons. In rare cases the retrosternal goitre may reach a size wherein it descends posterior to the heart. Here, cardiac surgeons may too be required. In the literature there are cases of the resection of large retrosternal goitres with concomitant cardiac surgery, most commonly with aortic valve replacement and coronary artery bypass grafting. The question of whether this can be performed concomitantly with mitral and/or tricuspid valve surgery has not been documented. We present the novel case of a 70-year-old gentleman who presented with dyspnoea, hoarseness and reduced exercise tolerance. Imaging demonstrated with a large retrosternal goitre, extending to the level of the inferior pulmonary veins with accompanying mitral regurgitation, due to P2 prolapse, (LVEF 30%), tricuspid regurgitation and atrial fibrillation. Due to the size and position of the goitre and the coinciding valvopathies, a single setting, multi-surgical specialty procedure was performed. A sternotomy and cervical incision were utilised for the initial approach and thyroidectomy performed. With subsequent haemostasis confirmed with great attention, the surgery proceeded with the establishment of cardiopulmonary bypass, a mitral valve replacement, tricuspid valve repair and left atrial appendage clipping. This case shows the importance of a multi-specialty approach to complex large retrosternal goitres and concomitant mitral and tricuspid surgery that can be safely performed in the same setting.

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