Concomitant surgery for aortic valve and lung cancer patients in an elder
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(2020) 15:257
CASE REPORT
Open Access
Concomitant surgery for aortic valve and lung cancer patients in an elder Hongfei Xu, Tingting Tao, Liang Ma, Weidong Li* and Yiming Ni*
Abstract Background: The treatment strategy for aortic valve and lung cancer patients includes concomitant or two-stage procedures. Conventional simultaneous operations are usually performed under the median sternotomy. Case presentation: A 72-year-old man was admitted to our hospital after experiencing chest tightness after activity for two months. Aortic valve regurgitation had been confirmed when squamous cell carcinoma of the lung was discovered. The therapeutic strategy for these patients is controversial. Considering the potential risk of tumour metastasis and the risk of cardiopulmonary bypass (CPB), we recommended concomitant transcatheter aortic valve implantation (TAVI) and a lobectomy. A trans-apical TAVI with left-sided intercostal thoracotomy was successfully performed, followed by an immediate video-assisted thoracoscopic surgery (VATS) lobectomy and selective lymph node dissection. Conclusions: We suggest that a one-stage surgery of pulmonary resection following TAVI is an acceptable and safe choice after careful evaluation and should be performed as soon as possible in response to lung cancer in elderly patients with aortic valve disease. Keyword: Transcatheter aortic valve implantation; lung cancer; concomitant surgery
Background Lung cancer can be incidentally discovered during preoperative evaluation of aortic valve regurgitation. The treatment strategy includes concomitant or two-stage surgery. The conventional simultaneous operation for valve replacement and lung resection is usually performed under the median sternotomy. Here, we describe a way to treat both diseases through concomitant transapical TAVI and VATS lobectomy and selective lymph node dissection, avoiding the adverse effects of CPB, repeated anaesthesia and pain without delaying lung cancer treatment. Case Presentation A 72-year-old male patient was admitted to our hospital. He had been experiencing chest tightness and blood in his sputum for two months. A transoesophageal ultrasound * Correspondence: [email protected]; [email protected] Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, Number 79 Qingchun Road, Hangzhou, China
revealed moderate to severe aortic valve regurgitation (Fig. 1a), a result of cusp prolapse due to generalized disease, and a chest X-ray indicated lung infections (Fig. 1b). Computed tomography (CT) scans before TAVI revealed a partial blockage in the left upper lobe bronchus (Fig. 1c), and a bronchoscopic biopsy revealed left upper lobe squamous cell carcinoma (Fig. 1d). In this complex situation of senile aortic valvular disease with lung cancer, we used a concomitant trans-apical TAVI with left-sided intercostal thoracotomy and then sleeve resection of the left upper lobe and lymph node dissection by right lateral decubitus. Our apical TAVI incision was located in the left fifth int
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