[HSF] Valvular disease with goitre

[Nasser F. Abou'Seada]

Dear Nand
why asking for a general surgeon to do it ?... I do agree with erdinc about
his approach.
1) what is the situation of the thyroid? .. you need a scan to determine its
functions and extension exactly ... ??? CT ?? ...... any Hypo/Hyper status
should be controlled prior to surgery.
2) endotracheal intubation should pose no challenge for the tained
anaesthiologist ....
3) I would start with retrosternal thyroid enucleation, with completion of
 of mass removal through a separate neck incision ... an assistant can take
care of that .....
4) completion of cardiac operation as indicated ......
5) armoured ETT .... is an excellent option ..... need for a tracheal stent
? ..if required ??? ... never seen one needed ... though I'm not an expert
"6 cases only".
6) requirement for trache ? ..... well ... we are always ready ... are not
we ?
7) trache at induction ???? ............. seems rather an odd
hypothetical argument !!!!!

Good luck with the case ....
your fight will be with airway disease ....
please keep us posted

NFA


On 6/10/07, nand kejriwal <nkkejriwal at gmail.com> wrote:
>
> Dear members
>
> 70 year female
> Severe AS, Mod MS, Severe MR, Mod sev TR, PH (PA 62)
> >
> > Chronic airway disease, FEV1 0.9L (40%) no significant reversibility
> > Awaiting MVR + AVR + TV repair / replacement
> >
> Also has large multinodular goitre with retrosternal extension
> > Right lobe extends to the level of arch
> > Trachea is deviated to left
> > At its most compressed point, measures 7mm in transverse & 2cm in AP
> > diameter.
> >
> > In view of moderate airflow obstruction and severely reduced gas
> transfer,
> > likely to need prolonged ventilatory support. The compressed trachea
> might
> > affect the ability to extubate.
> >
> > My plan is to do the heart; once heparin is reversed, let surgeons deal
> > with the goitre and then close the chest. However, someone suggested to
> do
> > the heart, let the haemodynamics/bleeding settle down and do goitre
> perhaps
> > next day.
> >
> > I shall be interested in the forum's opinion. Previous experience with
> > this combination? References?
> >
> > Thanks
> > Nand
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC