Contents

1. Anatomy 15

Fritz J. Baumgartner

Chambers 15

The Conduction System 18

The Cardiac Valves 18

Coronary Arteries 21

2. Cardiac Diagnosis 23

Matthew Budoff, Fritz J. Baumgartner and Bassam Omari

Echocardiography 23

Radionuclide Imaging 25

Cardiac Catheterization 26

CT Cardiac Imaging 29

Coronary Artery Calcification and Atherosclerosis 30

Non-invasive Angiography 30

Spiral CT 30

Magnetic Resonance Imaging (MRI) 30

3. Cardiopulmonary Bypass and Myocardial Protection 33

Fritz J. Baumgartner

General Principles 33

Cardioplegia 34

Technique 36

Femoral-Femoral Bypass 38

Left Atrial-Femoral Bypass 38

Intra-Aortic Balloon Pump 39

Pathophysiology of Cardiopulmonary Bypass 39

Autologous Transfusion 41

pH and CO2 Monitoring on CPB 42

Air Embolus 42

Cardiopulmonary Bypass During Pregnancy 43

Sickle Cell Anemia 43

Cardiopulmonary Bypass in Chronic Renal Disease 44

CNS Injury in Surgery of the Descending Aorta 44

Intraoperative Heart Failure 45

Venovenous Bypass 46

4. Cardiothoracic Anesthesia 53

John R. Charney

Monitoring 53

Mixed Venous Oxygen Saturation 53

Right Ventricular Ejection Fraction (Rvef) 54

Transesophageal Echocardiography (Tee) 54

Properties Of Ultrasound 54

Doppler Flow 55

Color Flow Doppler 55

2 Dimensional Imaging 56

Anesthetic Agents 57

Synthetic Opiates 57

Inhalational Agents 57

Other Anesthetics 58

Muscle Relaxants 59

Coagulation 61

Thoracic Anesthesia 64

5. Coronary Artery Disease 69

Fritz J. Baumgartner and Matthew Budoff

Evaluation of the Coronary Patient 69

Untreated Survival 70

Unstable Angina 70

Percutaneous Transcoronary Angioplasty (PTCA) 71

Coronary Bypass Surgery 73

Ischemic Ventricular Septal Defect and Mitral Regurgitation 79

Combined Carotid and Coronary Artery Disease 84

Ischemic and Nonischemic Ventricular Tachycardia 86

6. Valvular Heart Disease 89

Fritz J. Baumgartner

Aortic Valve Disease 89

Mitral Valve Disease 94

Tricuspid Valve Disease 105

Mechanical and Bioprosthetic Cardiac Valves 109

Techniques of Combined Valve Procedures 114

Endocarditis 115

Aortic Allograft and Autograft Procedures 116

7. Aortic Aneurysm/Dissections/Ruptures 123

Fritz J. Baumgartner

General Classification 123

Aortic Dissection 123

Thoracic Aortic Aneurysms 134

Traumatic Aortic Rupture 143

8. Hypertrophic Obstructive Cardiomyopathy 147

Bassam Omari, Fritz Baumgartner

Hypertrophic Obstructive Cardiomyopathy 147

Cardiac Tumors 148

9. Minimally Invasive Heart Surgery 151

Fritz Baumgartner

"Minimally Invasive" Valve Surgery 152

MIDCAB 153

OPCAB 155

Thoracotomy for Obtuse Marginal OPCAB 158

10. ICU Management l6l

Fritz J. Baumgartner, John Robertson, Bassam Omari

Physiology 161

Postoperative Protocols at Harbor-UCLA 165

11. General Thoracic Anatomy lS5

Fritz J. Baumgartner

Surface Anatomy of the Lungs 185

Bronchopulmonary Segments 185

The Bronchial Tree 185

Pulmonary Arterial System 188

Pulmonary Venous System 188

Bronchial Arteries and Veins 191

Lymphatic System 191

12. Lung Cancer l95

Fritz J. Baumgartner

General 195

Nonsmall Cell Lung Cancer 195

Nonsmall Cell Carcinoma Staging 196

Small Cell Lung Cancer 198

Paraneoplastic Syndromes 199

The Approach to the Patient with a Lung Mass 200

Occult Cancer 203

Segmentectomy Versus Lobectomy 203

Radiation Therapy 204

N-2 Disease 204

T-3 Chest Wall Involvement 205

Superior Sulcus Tumors 205

Brain Metastases 207

Technical Considerations 208

13. Empyema 223

Fritz J. Baumgartner

Non-postresection Empyema 223

Postresection Empyema 225

14. Tuberculosis 229

Fritz J. Baumgartner

Pulmonary Tuberculosis 229

Thoracoplasty 231

Massive Hemoptysis 231

15. Chest Wall Tumors 233

Fritz J. Baumgartner

16. Mesothelioma 237

Fritz J. Baumgartner

17. Esophagus 239

Fritz J. Baumgartner

Anatomy 239

Esophageal Neoplasia 241

Esophageal Carcinoma 242

Malignant Tumor of the Lower Third of the Esophagus 243

Malignant Tumors of the Middle Third of the Esophagus 245

Malignant Tumors of the Proximal Third of the Esophagus 246

Colonic/Jejunal Esophageal Replacement 248

Unresectable Esophageal Cancer 249

Hiatal Hernia and Gastroesophageal Reflux 249

Motility Disorders 252

18. Mediastinal Masses 255

Fritz J. Baumgartner

Anterior Mediastinum 256

Myasthenia Gravis and Thymoma 257

Middle Mediastinum 259

Posterior Mediastinum 259

19. Thoracic Trauma 261

Fritz J. Baumgartner

Airway Obstruction 261

Tension Pneumothorax 262

Open Pneumothorax 263

Hemothorax 263

Flail Chest 263

Cardiac Tamponade 263

Aortic Rupture 265

Tracheobronchial Injuries 266

Esophageal Trauma 271

Pulmonary Contusion 271

Myocardial Contusion 272

Traumatic Diaphragm Rupture 272

Bony Chest Fractures 272

Injuries to the Cardiac Valves and Coronary Arteries 273

Transmediastinal Gunshot Wounds 273

Combined Chest, Abdominal and Head Trauma 273

20. Congenital Causes of Respiratory Distress 279

Fritz J. Baumgartner

21. Chest Wall Congenital Deformities 283

Fritz J. Baumgartner

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