cardiothoracic scars

Question 1

Answer 1

midline sternotomy

• valve surgery
• CABG
• cardiac transplant
• congenital cardiac defects

Question 1

signs of CABG

Answer 1

vein harvesting on legs

Question 2

mini-sternotomy

Answer 2

• for aortic valve replacement
• from the substernal notch to the 3rd or 4th intercostal space
• a J-shape towards the right.

Question 3

Answer 3

posterolateral thoractomy

• mid-spinal line to the anterior axillary line.

Question 4

Answer 4

anterolateral thoracotomy

• mid-axillary line to the lateral sternal border.

Question 5

indications for thoractomy

Answer 5

• lobectomy - malignancy / recurrent infection / trauama / infarction
• pneumonectomy
• open lung biopsy
• lung vol reduction
• bullectomy
• pleurectomy - recurrent pneumothoraces or effusions
• single lung transplant
• minimally invasive cardiac surgery
• oesophagectomy (look for laparotomy scars)

Question 6

signs of lobectomy and pneumonectomy

Answer 6

dull percussion
reduced/absent breath sounds

Question 7

Answer 7

clamshell incision

• widespread traumatic chest injury
• bilateral transplant - look for signs of immunocompromise
• malignancy

Question 8

signs of immunocompromise

Answer 8

• bruising or a cushingoid appearance from steroid use
• tremor or gum hypertrophy from cyclosporin use
• signs of infection
• signs of rejection or transplant failure.

Question 9

indications for lung transplant

Answer 9

CF
bronchiectasis
COPD
pul fibrosis

Question 10

Answer 10

subclavicular incision

• pacemaker insertion - usually palpable

Question 11

indications for pacemaker

Answer 11

AF
sick sinus syndrome
AV block
heart failure

defibrillator function

Question 12

types of pacemaker

Answer 12

1. single chamber - wire to RA or RV
2. dual chamber - 2 wires to RA and RV
3. triple chamber RA RV and LV

Question 13

what are triple chamber pacemakers used for

Answer 13

cardiac resynchronisation therapy - in certain HF pts

Question 14

borders of the safe triangle

Answer 14

• anterior border of latissimus dorsi,
• the lateral border of pectoralis major,
• the base of the axilla
• the 5th intercostal space.

Question 15

what is VATS surgery

Answer 15

keyhole surgery
2 or 3 small incision in ports
enter thoracoscope and surgical instruments tp manipulate issues

Question 16

indications for VATS surgery

Answer 16

biospy and / or removal of suspicious masses
pleurodesis - recurrent pleural effusion / pneumothorax
biospy of mediastinal nodes

Question 17

benefits of VATS surgery

Answer 17

1. reduce need for muscle division
2. reduce risk iatrogenic rib fracture
3. improved recovery time