University Clinic performs unique simultaneous surgery on heart and thyroid
Mitral valve prosthetics and goiter removal in a 72-year-old female patient took four hours.
The Clinic doctors were joined by Chief Cardiovascular Surgeon of the Ministry of Health of Tatarstan Roin Dzhordzhikia and Head of Oncology Department of the Republican Clinical Oncological Hospital Rinat Khamidullin.
The patient was admitted to the Clinic with sepsis, bacterial endocarditis and goiter descending into mediastinum. After the consultation, oncological surgeons said that they had only encountered such a massive retrosternal component of a goiter several times in their careers.
Before getting into the operating room, the woman underwent a long-term treatment by cardiologists and neurologists – against the background of bacterial destruction of the heart valves, she had a detachment of valve fragments with the development of a cerebrovascular accident and an abscess in the spleen.
“After the end of the acute period of the stroke, we decided to perform a heart operation. However, the woman’s condition was also aggravated by a giant goiter which descended into the retrosternal space and reached almost to the aorta. Keeping in mind the fact that cardiac surgical access is carried out through the dissection of the sternum, it was decided to perform a one-stage operation – removal of a sharply enlarged, multinodular thyroid gland and mitral valve replacement. During the intervention, the leaflets of the heart valve affected by bacteria were excised and a biological valve prosthesis was installed in their place, and the altered thyroid gland was completely removed. The surgery lasted just over four hours and was successful,” said Daniyar Khaziakhmetov, Head of Cardiac Surgery at the University Clinic.
Roin Dzhordzhikia commented on the specifics of such combined interventions, “During open heart surgery, special technologies are used – a heart-lung machine is connected, which works instead of the patient’s heart and lungs, and this requires blood thinning, the introduction of a special drug – heparin. It completely blocks blood clotting. After turning off the heart-lung machine and resuming the work of the patient’s heart, special drugs are administered that restore blood clotting. Any surgical intervention is associated with increased bleeding, so the complexity and risk of this combined operation increased several times. In the case of this patient, we first operated on the heart, and then, having made sure of stable hemodynamics and reliable hemostasis, the oncology surgeon proceeded to remove the thyroid gland.”
According to Rinat Khamidullin, such a large goiter is a rarity. Usually, the retrosternal component can be removed via neck access, “There are technologies and experience that allow us to do this. But in this case, sternotomy performed for heart disease was the only approach that allowed to remove this goiter, its intrathoracic component.”
He also mentioned the symphonic work of all the specialists involved, “I liked the clear communication in the operating room. Cardiac surgeons have a great deal of experience related to interventions on the heart, but we still know the pathology of the thyroid gland better, and the fact that cardiac surgeons have attracted specialists with extensive experience in surgical interventions for goiter is great. Therefore, the result of our joint work turned out to be so good. And, of course, the participation of Professor Roin Dzhordzhikia in the operation instilled confidence in the entire surgical team.”