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Single Stage Pulmonary Hydatid Cystectomy And Mitral Valve Replacement
SUSHIL K. SINGH, Vivek Tewarson, Sarvesh Kumar, Kumar Rahul, Bhupendra Kumar, Mohammad Zeeshan Hakim;
King George's Medical University, LUCKNOW, India
BACKGROUND: Hydatid disease most commonly involves lung and liver. Some patients might have additional comorbidities that can make management more challenging. We present a patient with left pulmonary hydatid cysts and valvular heart disease who was successfully managed with a ‘SINGLE STAGE’ surgical approach treating the lung first, followed by mitral valve replacement.
METHODS: Thirty seven years old female patient had Severe mitral regurgitation ( MR ) and Severe mitral stenosis ( MS ) with left atrial appendage ( LAA ) clot. Chest X Ray and CT chest incidentally revealed a 10 cm diameter oval shaped homogenous hypodense lesion in left upper lobe of lung also. IgG ELISA for Echinococcus was positive. Since patient had a large pulmonary hydatid cyst with valvular heart disease with LA clot, we planned to operate in single stage. Left posterolateral thoracotomy was done first. Hydatid cystectomy with capitonnage was done and chest closed with ICD drain.Patient was repositioned for Median sternotomy. Mitral valve was replaced with 29 mm SJM with removal of LAA clot and internal ligation of LAA orifice. Histopathology confirmed the diagnosis of hydatid cyst.RESULTS:Lung and liver are most frequent sites involved by hydatid disease. Simultaneous lung and liver compromise is observed in <10% of cases. The preferred treatment for Hydatid cyst is surgical, mostly staged, when there is simultaneous lung and liver hydatid cysts. Surgery becomes more problematic when patients have comorbidities, such as cardiac disease. In the context of additional pathology a sequence of surgical procedures should be determined to achieve best results. Our goal was to minimize the risk of rupture of the pulmonary hydatid to prevent contamination,and, prevention of LA clot embolization. In this unusual circumstance, we preferred to operate first on lung hydatid cysts and then MVR with LA clot removal and closure of LAA orifice.
CONCLUSIONS:Cardiac disease with simultaneous lung hydatid cysts, can be successfully managed with a single stage surgical approach. This should be tailored to the individual patient. Lung intervention followed by cardiac surgery proved to be successful in the management of our patient. Figure: CXR and CT thorax showing pulmonary hydatid cyst
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