Simultaneous minimally invasive uniportal atrial septal defect repair and pulmonary lobectomy: a case report

Background: Combination of non-oncological pulmonary and cardiac conditions is common entity in modern thoracic surgery, allowing concurrent surgical correction. Multiple publications in the literature address the success of simultaneous interventions for combined conditions, however almost all are performed with an open approach. Case Description: A 49-year-old male with past medical history significant for bronchiectasis, complicated by fibrosis of the middle lobe, presented with dyspnea, recurrent hemoptysis, and nonproductive cough. Echocardiography revealed a large atrial septal defect (ASD), biventricular enlargement with severe mitral and tricuspid regurgitation. After multidisciplinary evaluation, patient was taken to the operating room for simultaneous cardiac intervention with right middle lobectomy. The total duration of surgery was 332 min, with cross-clamp time of 79 min. Estimated blood loss was 800 mL. Patient was extubated 3 h postoperatively, chest tube was removed on postoperative day 4 and the patient was discharged home on postoperative day 8 without postoperative complications. Conclusions: In this article, we describe the first case of simultaneous thoracoscopic uniportal intervention with cardiopulmonary bypass (CPB) in the treatment of multiple congenital heart defects and pulmonary complications of bronchiectasis. Presented case demonstrates potential advantage and feasibility of minimally invasive simultaneous procedures in patients with concurrent pulmonary and cardiac conditions. The described approach allowed radical surgical intervention to address both problems in the single setting, while retaining advantage of minimally invasive intervention.