Simultaneous Surgery of Cardiac Myxoma and Thyroidectomy: Case Report and Short View
Author(s): Selman Dumani, Arvin Dibra, Laureta Dibra, Ermal Likaj, Alfred Ibrahimi, Devis Pellumbi, Majlinda Ikonomi, Altin Veshti
The practice of simultaneous cardiac and non-cardiac surgery is still debated today. The presence of cardiac and non-cardiac surgical diseases at the same time is a rare finding and generally, surgeries used to be performed in separated stages. In this presentation we will report a case of urgent myxoma resection and simultaneous surgery for multinodular thyroid gland hypertrophy. In our knowledge, there is no description in the literature of the simultaneous intervention of myxoma and thyroidectomy. We will also provide a brief overview of the current literature about the management strategies for patients who need both cardiac and non-cardiac surgeries.
Our patient is a 73 -year-old lady who came to the emergency department with a two-week history of shortness of breath. She has a long-standing history of arterial hypertension, type II diabetes mellitus and hyperthyroidism. The echocardiography revealed a hyperechogenic intracardiac mass in the left atrium, probably myxoma, attached by a small pedicle to the interatrial septum, measuring approximately 3 X 4 cm with regular contours. Additionaly, a large mass was found on the anterior neck during physical examination.
The CT scan revealed a hypertrophic multinodular thyroid gland with numerous hypodense nodules, some of which are calcified, with retrosternal extension.
The indication for cardiac surgery was urgent. Due to the retrosternal extension of the thyroid gland we consulted with a general surgeon in order to make a plan on the surgical aproach simultaneous or two-stage surgery. We decide to perform simultaneous surgeries starting with total thyroidectomy and continuing with in the same stage with myxoma resection under extra corporeal circulation. The patient had a very good postoperative course. The patient left the hospital in very good conditions.
In most published meta-analyses and studies, it is recommended to perform cardiac and non-cardiac interventions simultaneously, with very satisfactory intra- and post-operative results.
Conclusion: Simultaneous thyroidectomy and cardiac myxoma surgery can be a safely performed with very good results. The literature refer very good results of simultaneous cardiac and non-cardiac surgeries.