Hypertension

Generally we like to keep our patient's systolic blood pressures below 120-130 mmHg. Blood pressures above this level for the average cardiac patient are excessively high. It is not uncommon for a patient who is not bleeding postop-eratively to suddenly start bleeding from suture lines when the blood pressures are elevated. In addition, the work required by the recovering postoperative heart is markedly increased when systolic hypertension occurs. The causes of postoperative hypertension are...

Myasthenia Gravis And Thymoma

Myasthenia gravis is a condition in which the patient develops progressive muscle weakness secondary to acetylcholine receptor antibodies. Medications used to treat myasthenia gravis include anti-cholinesterase medications which block the cholinesterase-mediated removal of the acetylcholine from its receptor. The classifications of myasthenia gravis include ocular and generalized. In the ocular group, there is involvement of ocular muscles only with ptosis and diplopia. This is a very mild form...

Postcoarctation repair

It is well known that post-coarctation repair individuals frequently develop a severe hypertensive response. This may be accompanied by abdominal ischemia as well as disruption of various suture lines. Therefore, frequent examinations of the abdomen as well as the institution of Nitroprusside and or Esmolol to control the paradoxical hypertension should be initiated. The hypertension associated with this disease state may be prolonged and these patients may need to be switched to oral...

Coronary Artery Disease

Baumgartner and Matthew Budoff The patient who presents with chest pain needs to be thoroughly evaluated. A complete history and physcial is first undertaken, taking special care to note the presence of cardiac risk factors history of premature family history of CAD, hypertension, diabetes, obesity, hypercholesterolemia and smoking. A physical examination should focus on the cardiovascular system, followed by laboratory assessment of cardiac enzymes (troponin, CPK and MB), a chest...

Info

Sleeve Resection Bronchus Intermedius

On the left side, an apical or basal segmentectomy may again be performed for the lower lobe. Overall, segmentectomy is most often done for the superior segments of the lower lobes. The next most common segmentectomy is the lingulectomy. These will now be discussed. For the superior segmentectomy of either side, first the arterial and venous supplies of the superior segment are taken. This includes careful dissection to avoid injury to the right middle lobe artery on the right and...

Mitral Valve Replacement Chordal Preservation

Fossa Ovalis

Standard mitral exposure. Left atriotomy begins just anterior to right superior pulmonary vein. This affords excellent exposure of the mitral valve in most cases. Fig. 6.7b. Dubost mitral exposure. A bi-atrial, transseptal incision is made going through the interatrial septum at the fossa ovalis. Bicaval can-nulation and snares are required. the intra-annular position of the valve prevents the cordae and annulus from impinging on the leaflets of the mechanical...

Hiatal Hernia And Gastroesophageal Reflux

Diaphragm Crura

The overall management of patients who present with dysphagia or heartburn must include, of course, a cardiovascular history and examination since the suspicion of ischemic cardiac disease or other myocardial dysfunction must always be in mind. The esophageal problems that may result in dysphagia or heartburn can include carcinoma, gastroesophageal reflux or motility disorders including achalasia or diffuse esophageal spasm . The preoperative evaluation of patients who present with suspected...

Chest Wall Tumors

Sarcome Costochondral

The tumors of the chest wall fall into several classifications. They may be of bony or soft tissue origin. They may be benign or malignant and those that are malignant may be primary or metastatic. They may be lesions that invade the chest wall from the lung, pleura, mediastinum or breast. Benign rib tumors include osteochondroma, chondroma, fibrous dysplasia and histiocytosis X. Malignant rib tumors include multiple myeloma, osteosarcoma, chondrosarcoma and Ewing's sarcoma. Osteochondroma is...

The Bronchial Tree

Carina Angle Atrium

The trachea bifurcates at about the level of the fourth thoracic vertebra into the right and left mainstem bronchi. The tracheal bifurcation at the carina is considered a major anatomical landmark where several anatomic events occur. These include the origin of the great vessels coming off the aorta and the entry of the Fig 11.1a. Surface anatomy of the lungs, viewed anteriorly. Fig 11.1a. Surface anatomy of the lungs, viewed anteriorly. Fig 11.1b. PA and lateral x-rays of a normal chest and...

Anatomy

Deep Cervical Fascia

The esophagus is a continuation of the pharynx and ends at the cardia of the stomach. The transition from pharynx to esophagus is at the lower border at the 6th cervical vertebra which corresponds to the cricoid cartilage anteriorly. The esophagus deviates to the left in the lower portion of the neck, then returns to the midline in the mid-portion of the thorax near the bifurcation of the trachea. In the lower portion of the thorax the esophagus again deviates to the left to pass the...

Venovenous Bypass

Cannulas For Venoveno Bypass

Another extracorporeal technique used in certain special situations is venovenous bypass VVB . It is used predominantly for vascular isolation of difficult inferior vena cava procedures. VVB was originally described for the anhepatic phase of liver transplantation. Other uses include the resection of renal and adrenal tumors with caval involvement and trauma to the retrohepatic inferior vena cava. VVB drains blood from the lower half of the body via a centrifugal pump into the central venous...

Lymphatic System

Lymphatic System Mediastinal

The lymphatic system of the lung includes intrapulmonary lymph nodes N-1 and mediastinal lymph nodes N-2 . The intrapulmonary nodes are within the visceral pleural envelope. These are shown in Figure 11.6. The mediastinal lymph nodes are also shown in Figure 11.6. They can be classified numerically to include node stations 1, 2, 3, 4, 5, 6, 7, 8 and 9. It should be noted that level 10 nodes may be considered either intrapulmonary or mediastinal, depending on the level that they are sampled at....

Coronary Arteries

Posterolateral Ventricular Branch

These consist of a left main coronary artery which bifurcates to the circumflex coronary artery and left anterior descending coronary artery Fig. 1.4 . The orifice of the left main coronary artery lies in the left coronary sinus. The orifice of the right coronary artery arises from the right coronary sinus. The circumflex coronary artery lies in the groove between the left atrium and left ventricle adjacent to the coronary sinus. The circumflex coronary artery gives off obtuse marginal branches...

Technique

Antegrade Cardioplegia Cannula

In summary, cannulation and cardiopulmonary bypass is instituted by placing aortic pursestrings in the distal ascending aorta followed by venous pursestrings. The venous pursestring is either a single right atrial pursestring in the case of coronary bypass surgery or aortic valve replacement, or in the case of mitral valve replacement or tricuspid valve procedures, a separate superior vena cava and inferior vena cava pursestring. Figure 3.2 shows the cardiac cannulation sites for various...