Cardiothoracic Surgery

1
Cardiothoracic Surgery

• Hannah Zimmerman, MD
• Surgery Resident

2
Ischemic Heart Disease

• Causes
• Atherosclerosis of the coronary arteries
• Valve disease
• Vasculitis
• Congenital disease
• Anatomy
• Right Coronary dominance
• Left Coronary dominance

3
Pathophysiology of Ischemia

• Ischemia is secondary to a lack of blood flow to
  a region of the heart which increases the
  metabolic demands on the myocardium
• What determines demand wall tension, heart rate,
  contractility
• Atherosclerotic plaque decreases flow,
  multifocal, multivessel
• Plaque rupture worsening symptoms

4
Risk Factors

• HTN
• Smoking
• Hyperlipidemia
• Obesity
• Diabetes
• Family History

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Signs Symptoms

• Fatigue
• Angina
• Dyspnea
• Edema
• Palpitations
• Syncope

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Diagnosis

• EKG - ST segment elevation or depressions,
  inverted T waves, or Q waves
• Stress Test
• Echocardiography estimated ejection fraction
• Cardiac Catherization angiography, identifies
  sites of lesions, qualifies lesions

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EKG
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Treatment

• Medical ASA, beta blockers, calcium channel
  blockers, ACE Inhibitors, diuretics, nitrates
• PTCA Percutaneous Transluminal Coronary
  Angioplasty
• Surgery CABG Coronary Artery Bypass Grafting

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Coronary Artery Bypass Grafting

• Bypass areas of obstruction of coronary artery
  vessels using internal mammary artery (IMA) or
  reversed saphenous vein
• 3 or more vessels

• Indications
• Stable angina, unable to medically manage
• Unstable angina
• Post-infarct angina
• 2-3 vessel disease with decreased LV fxn
• Left Main Disease
• Complications of PTCA stent

10
Lung Cancer

• Types
• Small Cell
• Central
• Sensitive to chemotherapy
• Non Small Cell
• Includes squamous, large cell, adenocarcinoma
• Poor response to chemotherapy
• Treatment surgery
• Prognosis Varies

http//adam.about.com/encyclopedia/Lung-cancer-fro
ntal-chest-x-ray.htm
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Lung Cancer

• Leading cause of cancer death in both men and
  women in the US
• Smoking most preventable risk factor
• Other Causes second hand smoke, radon gas,
  asbestos, arsenic, nickel

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Signs Symptoms

• Chronic Cough
• Hemoptysis
• Stridor
• Dyspnea
• Hoareness
• Dysphagia
• Paraneoplastic Syndromes

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Diagnosis of Lung Mass

• CXR Lung Nodule
• stable for 2 years, no further evaluation
• New onset within the last 2 months unlikely
  malignant
• CT Chest location, mediastinal invasion,
  evaluate liver and adrenal glands for metastasis
• Bronchoscopy central location, biopsy
• Thoracentesis evaluate pleural effusions
  suspicious for malignancy

14
Lung Cancer
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Lung Cancer

• Small Cell Lung Cancer
• Ectopic peptide ACTH, Gastrin, AVP, Calcitonin
• 80-90 response to radiotherapy
• 50 complete regression with chemotherapy
• Surgical resection NOT indicated

• Non Small Cell Lung Cancer
• Ectopic peptide PTH
• 30-50 response to radiotherapy
• 5 complete regression with chemotherapy
• Surgery indicated
• Subtypes adenocarcinoma, squamous cell, large
  cell

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Thoracic Aortic Aneursyms

• Classification
• DeBakey
• Type I Ascending and Descending Aorta
• Type II Ascending aorta only
• Type III Descending aorta only
• Stanford
• Type A Ascending aorta
• Type B Descending Aorta

http//www.vascularweb.org/patients/NorthPoint/Tho
racic_Aneurysm.html
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Signs Symptoms

• Tearing or ripping chest pain radiating to back
• Neuro symptoms syncope, coma, convulsions,
  hemiplegia
• Hoarseness
• Stridor
• Dysphagia
• Absent or diminished pulses

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Diagnosis

• CXR
• widened mediastinum
• Abnormal aortic contour
• Contrast CT
• MRI/MRA
• Angiography
• TEE
• TTE

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Thoracic Aortic Aneurysms
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Treatment

• DeBakey II medical management, control
  hypertension with nitroprusside or labetalol
• Surgery for ruptured aneurysms

21
Total Artificial Heart
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