# Perioperative management of a patient with tuberculous destroyed lung and ascending aortic aneurysm undergoing a Bentall procedure: a case report

## TL;DR

A rare case of a patient with lung damage from tuberculosis and an aortic aneurysm successfully underwent heart surgery with careful planning.

## Contribution

This case report presents a successful surgical management strategy for a rare combination of tuberculosis-related lung damage and aortic aneurysm.

## Key findings

- The patient underwent a Bentall procedure without tuberculosis reactivation or major complications.
- Multidisciplinary collaboration and customized perioperative strategies are crucial for managing such complex multimorbidities.
- Early diagnosis and timely surgery improve outcomes in patients with tuberculous destroyed lung and aortic aneurysm.

## Abstract

The coexistence of tuberculous destroyed lung (TDL) and ascending aortic aneurysm represents a rare multimorbidity, posing significant challenges for perioperative management in patients requiring cardiopulmonary bypass (CPB)-assisted major vascular surgery. The clinical manifestations of this polycoexisting disease may be asymptomatic or present as symptoms of one of the diseases or both. Currently, there is no universally accepted diagnostic protocol available for the definitive diagnosis of complex conditions such as tuberculosis and its comorbidities.

A 58-year-old woman presented with a 1-month history of cough, expectoration, chest tightness, and dyspnea, which had exacerbated over the preceding week. Pulmonary computed tomography revealed left lung fibrosis with architectural destruction, along with aneurysmal dilation of the ascending aorta. Her medical history included tuberculosis (diagnosed 20 years earlier and treated with anti-tuberculosis therapy for 6 months), hypertension (managed with levamlodipine besylate 5 mg daily), and recurrent pulmonary infections. After multidisciplinary evaluation, she underwent an elective Bentall procedure under CPB. Postoperatively, there was no evidence of tuberculosis reactivation or major complications, and she was discharged after 23 days of hospitalization.

Successful surgical intervention for TDL combined with thoracic aortic aneurysm is rarely reported. Early diagnosis and timely surgery are critical for improving patient outcomes. This case highlights the importance of multidisciplinary collaboration and customized perioperative strategies in managing such complex multimorbidities.