Cardiac and thoracic surgery Flashcards
Epicardium
Myocardium
Endocardium
Above or upon; heart; noun ending – “layer”
Muscle; heart; noun ending – “layer”
Within; heart; noun ending – “layer”
Heart is surrounded by fluid-filled sac called the:
Pericardium = around; heart; noun ending – “layer”
4 chambers (atria, ventricles); Valves
Right atrium
Tricuspid - and it has 3 leaflets
Right ventricle
left atrium
Bicuspid/Mitral - and it has 2 leaflets
left ventricleWhat are the chordae tendinae and what is their function?
Fibrous cords attached to valve cusps; prevent cusps from folding back into atrium
The semi-lunar valves are:
Aortic and pulmonic (pulmonary)
Flow of blood through heart
Superior and inferior venae cava (empty into the) Right atrium (and pass through the) Tricuspid valve (into the) Right ventricle (Blood goes to the lungs through the) Pulmonary valve (to the) Pulmonary artery (where it is oxygenated in the lungs and returns to the heart via the) (where it is oxygenated in the lungs and returns to the heart via the) Pulmonary veins (Those structures empty into the) Left atrium (and pass through the) Bicuspid valve (into the) Left ventricle (Blood is then pumped through the) Aortic valve (into the) Aorta (and out to the body)
Cardiac intrinsic conduction system
Impulse originates at the:
S-A node (sino-atrial)
and travels through the internodal pathways to the:
A-V node
the impulse spreads to the:
A-V bundle (Bundle of His)
which divides into the:
Right and left bundle branches
which terminate in the
Purkinje fibers (AKA: myoconduction fibers)Why is the pump-oxygenator (CPB) used in cardiac surgery?
Assumes roles of heart and lungs so heart can be stopped during procedure.
Why is hypothermia used in CPB?
To protect the heart muscle (myocardial protection)
Which three means are used to achieve this purpose?
Systemic hypothermia; topical myocardial hypothermia; cold potassium cardioplegia solution; and ice slush or iced saline.
List 4 diagnostic tests used in thoracic surgery
Chest x-ray
CT
MRI
Pulmonary angiography
List 4 items of special equipment used for thoracic surger
Cell saver Headlight and light source Defibrillator with sterile internal paddles Video tower for MIS Advanced patient monitoring
Which structures form the skeletal framework of the thorax?
Formed by sternum, ribs, and thoracic vertebrae
List 3 parts of the sternum
Manubrium; Body (gladiolus); Xiphoid
What is the diaphragm and what is its function?
Muscle that separates thorax from abdomen
primary muscle of breathing
The Diaphragm contracts during inhalation to pull air into the lungs and during exhalation, the diaphragm relaxes and the air is pushed out of lungs.
Where are the intercostal nerve, artery, and vein located?
On the inferior edge of the corresponding rib
What is the mediastinum?
Anatomic region; cavity between R and L thoracic cavities; no specific function
What is contained in the mediastinum?
Esophagus, trachea, pericardium, great vessels, thymus, lymph nodes
What is the parietal pleura?
What is the visceral pleura?
Lining of the inner surface of each hemi-thorax The reflection (or folding) of the parietal pleura over the lung tissue
What is the pleural space?
What is pneumothorax?
Potential space between parietal and visceral pleurae
Air in the chest cavity
What is the function of the lungs?
Essential organs of respiration; facilitate O2/CO2 exchange
Right lung contains:
Left lung contains:
3 lobes
2 lobes
Hilum what is it and which structures exit here?
The “root” of lung where vital structures enter and leave the lung
Bronchus, nerves, lymphatics and pulmonary artery and veins
Define CABG
Coronary artery bypass graft
Anatomy/physiology CABG
Heart, pericardium, epicardium, myocardium, endocardium;
Coronary arteries: Left anterior descending (LAD), circumflex, right coronary artery;
Ascending aorta
Saphenous vein
IMA
Physiology: circulation to the heart muscle
IMA
internal mammary artery
Define MID-CABG
Minimally invasive direct coronary artery bypass graft
Anatomy/physiology MID-CABG
Heart, pericardium, epicardium, myocardium, endocardium;
Coronary arteries: Left anterior descending (LAD), circumflex, right coronary artery;
Ascending aorta
Saphenous vein
IMA
Physiology: circulation to the heart muscle
Pathology/indication CABG
Coronary artery disease (CAD) due to atherosclerosis in one or more coronary arteries
Pathology/indication MID-CABG
CAD; due to atherosclerosis; usually for one vessel; the left anterior descending coronary artery (LAD)
Define Mediastinoscopy with lymph node biopsy
Visual exam, mediastinum; with excision of lymph nodes for pathologic exam
Anatomy/physiology Mediastinoscopy with lymph node biopsy
Surgical Anatomy/physiology
Mediastinum
FYI: Mediastinum contains Heart; Great vessels: aortic arch
Tracheobronchial junction (carina)
Trachea
Bronchi (FYI: right and left main stem bronchi)
Lymph nodes
Physiology: None specific to mediastinum; it is simply a location containing many structures
Pathology/indication Mediastinoscopy with lymph node biopsy
Lung cancer; determine metastatic spread to lymph nodes
FYI: may also be used to stage esophageal cancer
Define Thoracoscopy AKA: VATS
Video-assisted thoracic surgery
Visual exam; chest cavity
Anatomy/physiology Thoracoscopy AKA: VATS
Lung; lobes (3 right; 2 left) Bronchi Pulmonary arteries/veins Ribs; intercostal muscles Pleurae (parietal and visceral) Diaphragm Mediastinum Pericardium Physiology: respiration
Pathology/indication Thoracoscopy AKA: VATS
Diagnostic procedure
Treatment for:
Peripheral lung lesion (do a wedge resection)
Lung tumor (lobectomy)
Excessive pericardial fluid (do a pericardial window)
Pulmonary blebs (like blisters; resect affected areas)
Pleural effusion (drain/possible pleurodesis)
Emphysema (lung volume reduction)
Define Decortication of the lung
Removal of a restrictive membrane from the lungs
Anatomy/physiology Decortication of the lung
Lung; lobes (3 right; 2 left) Bronchi Pulmonary arteries/veins Ribs; intercostal muscles Pleurae (parietal and visceral) Diaphragm Mediastinum Pericardium Physiology: respiration
Pathology/indication Decortication of the lung
Empyema (pus in the thoracic cavity)
Define Lobectomy
Excision of a lobe of the lung
Anatomy/physiology Lobectomy
Lung; lobes (3 right; 2 left) Bronchi Pulmonary arteries/veins Ribs; intercostal muscles Pleurae (parietal and visceral) Diaphragm Mediastinum Pericardium Physiology: respiration
Pathology/indication Lobectomy
Peripheral pulmonary tumor without hilar node involvement
Define Pulmonary embolectomy
Excision of a blood clot in the pulmonary artery
Anatomy/physiology Pulmonary embolectomy
pulmonary artery/ies
Pathology/indication Pulmonary embolectomy
pulmonary artery blood clot
Define Thoracotomy/pneumonectomy
Incision into thoracic cavity with excision of entire lung
Anatomy/physiology Thoracotomy/pneumonectomy
Lung; lobes (3 right, 2 left) Bronchi Pulmonary arteries/veins Ribs; intercostal muscles Pleurae (parietal and visceral) Diaphragm; mediastinum; pericardium Physiology: respiration
Pathology/indication Thoracotomy/pneumonectomy
Bronchogenic carcinoma
pertaining to; origin; bronchus
Define Lung Transplantation
Replacing a diseased lung with a donor lung
Anatomy/physiology Lung Transplantation
Lung; lobes (3 right, 2 left) Bronchi Pulmonary arteries/veins Ribs; intercostal muscles Pleurae (parietal and visceral) Diaphragm; mediastinum; pericardium Physiology: respiration
Pathology/indication Lung Transplantation
Emphysema (COPD = emphysema + chronic bronchitis)
Idiopathic pulmonary fibrosis
Pulmonary hypertension
Bilateral: cystic fibrosis
Atherosclerosis
Cardiomyopathy
Coarctation of aorta
Abnormal condition; fatty plaque; hardening resulting loss of elasticity
Disease; heart; muscle
Narrowing of the aortic arch
Surgical intervention:
Atherosclerosis
Cardiomyopathy
Coarctation of aorta
Carotid endarterectomy-Excision of atherosclerotic plaque in the carotid artery
Left ventricular assist device (VAD); implantable cardiac defibrillator (ICD); heart transplant
Resection and end-to-end anastomosis; patch aortoplasty; left subclavian flap aortoplasty; or tubular bypass grafts
Patent ductus arteriosus
Tetralogy of Fallot
Myocardial infarction
Failure of closure of an embryologic blood vessel; the connection between pulmonary artery and aorta
A group of 4 congenital heart defects;
“Heart attack”; interruption of blood flow to heart muscle
Surgical intervention:
Patent ductus arteriosus
Tetralogy of Fallot
Myocardial infarction
Transcatheter occlusion
Repair of Tetralogy of Fallot
Rurgical is not first line of treatment
Rheumatic heart disease
Mitral stenosis
Mitral regurgitation
Scarring or damage to heart, especially heart valves due to inflammation from rheumatic fever
Abnormal condition; narrowing; pertaining to bicuspid valve
Backflow through the biscuspid valve; “incompetent” valve
Surgical intervention:
Rheumatic heart disease
Mitral stenosis
Mitral regurgitation
Heart valve repair or replacement
Mitral valvotomy or replacement
Mitral valve repair or replacement
Aneurysm
Coronary artery disease (CAD)
Gangrene, foot
A ballooning or abnormal dilation of a blood vessel; (of the aorta)
Atherosclerosis of the coronary arteries
Tissue death due to lack of blood supply to the foot
Surgical intervention:
Aneurysm
Coronary artery disease (CAD)
Gangrene, foot
Aneurysmectomy (Excision of aneurysm with placement of aortic graft); open or endoscopic
Coronary artery bypass graft (CABG)
Amputation
Thrombophlebitis
Varicose veins
Pleural effusion
Inflammation; blood clot; vein
Incompetent venous valves
Fluid in the thoracic cavity between the parietal and visceral pleurae
Surgical intervention:
Thrombophlebitis
Varicose veins
Pleural effusion
Venous thrombectomy (Excision of blood clot in a vein) Excision of varicose veins Thoracocentesis with placement of chest tube/s; talc pleurodesis; or decortication
Pulmonary embolus
Cystic fibrosis
Empyema
Blood clot in the pulmonary artery or branches
Genetic disease primarily affecting lungs; thick secretions
Collection of pus in body cavity, particularly the pleural space
Surgical intervention:
Pulmonary embolus
Cystic fibrosis
Empyema
Pulmonary embolectomy
Double-lung transplant (at end-stage)
Decortication of lung (Excision of restrictive fibrous tissue covering the lung)
Pneumothorax
Hemothorax
Air in the pleural cavity (FYI: from outside trauma or inside rupture of blebs)
Blood in the pleural cavity
Surgical intervention:
Lung cancer
Pneumothorax
Hemothorax
Thoracotomy (incision into thoracic cavity) with lobectomy (excision of a lobe of the lung) or pneumonectomy (excision of an entire lung (right or left)
Insertion of chest tube/s
Thoracotomy and insertion of chest tubes
Define Pectus excavatum repair
Repair of a posterior displacement of the sternum
Anatomy/physiology Pectus excavatum repair
Sternum and ribs
Pathology/indication Pectus excavatum repair
Posterior displacement of the sternum with impaired cardiorespiratory function
