Visual laryngeal mask for intraoperative ventilation in mitral valve surgery with tuberculous destroyed lung: a case report

Tuberculous destroyed lung (TDL) represents a severe, irreversible sequela of chronic pulmonary tuberculosis, characterized by extensive parenchymal destruction, fibrosis, and volume loss that results in significant ventilatory dysfunction. When complicated by rheumatic mitral valve disease (RMVD), these patients present formidable challenges for intraoperative respiratory management and surgical safety, particularly under cardiopulmonary bypass. We report a 56-year-old female with left TDL complicated by severe mitral regurgitation and moderate mitral stenosis. She underwent biological mitral valve replacement, tricuspid annuloplasty, left atrial appendage amputation, and pulmonary vein isolation under cardiopulmonary bypass. A visual laryngeal mask airway was innovatively adopted for intraoperative respiratory maintenance as an alternative to traditional endotracheal intubation. The device was removed immediately upon conclusion of the procedure. Despite the patient's unilateral effective pulmonary ventilation, stable oxygenation and ventilation were maintained throughout the operation. Postoperatively, the patient developed a mild right pleural effusion, which was relieved by thoracentesis; no severe respiratory complications such as hypoxemia or acute respiratory distress syndrome occurred. She was discharged on postoperative day 26. A 3-month follow-up demonstrated good recovery of both cardiac and respiratory function. This case highlights the clinical value of the visual laryngeal mask airway for intraoperative respiratory management in patients with TDL complicated by cardiac valve disease. It further emphasizes the importance of multidisciplinary team (MDT) collaboration and fast-track anesthesia principles in preoperative evaluation, surgical planning, intraoperative management, and postoperative complication control for such high-risk patients.