Chapter 22: Cardiothoracic Surgery Flashcards
What are the three divisions of the thoracic cavity?
Right pleural cavity
Left pleural cavity
Mediastinum
Right pleural cavity contains the right lung. How many lobes does the right lung have?
Three lobes
Left pleural cavity contains the left lung. How many lobes does the left lung have?
2 lobes - because heart is on the same side
From superior to inferior, name the structures in the mediastinum:
• Heart with great vessels
• Thymus
• Trachea
• Esophagus
• Lymph nodes
Esophagus / Trachea, Thymus, lymph nodes, and heart with great vessels
The thoracic cavity is bounded as follows:
Anteriorly: ______ and _____ cartilages
Posteriorly: ______ vertebrae
Laterally: _____
Inferiorly: ______
Anteriorly: Sternum and Costal cartilages
Posteriorly: Thoracic vertebrae
Laterally: Ribs
Inferiorly: Diaphragm
Place the structures of the sternum superior to inferior:
• Body
• Xiphoid process
• Manubrium
Manubrium, Body, xiphoid process
How many ribs in total and how many are true ribs, false ribs, and floating ribs?
12 total: 7 true, 3 false, and 2 floating
The seven true ribs are connected to the sternum by ______ cartilage
Costal
The three false ribs are connected to the sternum ______ by costal cartilage
Indirectly
True or Flase: The two floating ribs are not attached to the sternum
True
Parietal pleura lines the inner surface of the ____, pericardium of the ____, and superior surface of the _____.
Ribs; heart; diaphragm
Visceral pleura covers the outer surface of the _____.
Lungs
Pleural space is the small space between parietal pleura and visceral pleura. It contains _____ fluid that prevents friction between the lungs and pleura during respiration
Serous
Principal muscles associated with inspiration are the _____ and ______ intercostals muscle
diaphragm; external
Accessory muscles of inspiration are the
_______________ and ______.
sternocleidomastoid; scalenes
Principal muscles associated with
expiration are the ______ intercostals, external oblique, internal oblique, transversus abdominis, and _____ abdominis.
internal; rectus
Act of respiration: Place the following in order
• Size of thoracic cavity increases.
• Diaphragm and external intercostals muscles contract.
• Ribs and sternum elevate.
• Pulmonary pressure decreases, thus forcing air into the lungs.
• Diaphragm and external intercostals muscles contract.
• Ribs and sternum elevate.
• Size of thoracic cavity increases.
• Pulmonary pressure decreases, thus forcing air into the lungs.
The _____ extends from the larynx to bronchi and functions as a passageway for air to and from the lungs
Trachea
The trachea is formed by: _____ muscle, _____ cartilage (C-shaped rings that prevent trachea from collapsing), and the Inner wall is lined with _____ mucosa.
Smooth; Hyaline; ciliated
The trachea divides at the _____ into right and left bronchi
Carina
Bronchi are composed of _____ muscle and ______ rings.
Inner wall is lined with _____ mucosa.
Mucosa is composed of _____ cells.
smooth; cartilaginous; ciliated; goblet
Goblet cell secretions trap foreign particles; ____ pass the particles forward into the throat to be expelled as an aid in preventing respiratory tract infection.
cilia
Place in the correct order:
• Bronchus enter the lungs and divide into
• Lobules
• Bronchioles
• Alevoli
• Bronchi
• alveolar ducts
• Bronchus enters lung and divides into secondary lobar branches
• Lobar branches divide into segmental bronchi.
• Segmental bronchi divide into bronchioles.
• Bronchioles end in alveolar ducts and alveoli.
Alevoli exchange oxygen and ____ ____.
Carbon dioxide
Lungs extend from just slightly below the _____ to the ______.
clavicle; diaphragm
Ancillary structures of the Lungs:
Bronchus, pulmonary _____, superior and inferior pulmonary _____, and lymphatic _____
artery; veins; vessels
The slight concave portion on the medial side of each lung where the bronchus and other structures enter is called the:
Hilium
The _____ lung has superior and inferior lobes separated by a fissure
The _____ lung has superior, middle, and inferior lobes separated by fissures
Left; Right
Blood low in oxygen travels from the right ventricle of the heart through the ____ branch of the ______ artery to the Left lung to be oxygenated.
Blood travels in the same way to the right lung, except it travels through the ____ branch of the _____ artery.
Left; pulmonary
Right; pulmonary
Oxygenated blood leaves the lungs through the pulmonary _____ and enters the left _____ of the heart
Veins; atrium
_______ arteries that arise from the aorta supply the bronchi, bronchioles, and tissue of the lungs.
Bronchial
__________ is an invasive diagnostic and/ or therapeutic procedure for the evaluation of hemoptysis, infection, carcinoma of the lung,. and damage to the lungs due to smoke inhalation.
It is useful for retrieving foreign objects lodged in an airway and for laser treatment of endobronchial tumors and evaluation of the transplanted lung
Bronchoscopy
______ tubes attach to suction for collection of mucous or bronchial washing specimens
Lukens
Bronchoscopes are either flexible or rigid.
Rigid Bronchoscopy is typically performed for removal of ______ ______.
Foreign objects
When positioning the patient for a rigid bronchoscopy, the head is slightly tilted to the ____ when the surgeon wants to view the right bronchi and slightly tilted to the____ to view the left bronchi.
Left; right
_____________ is performed for the evaluation of nodal involvement or mediastinal masses in patients with lung carcinoma.
Mediastinoscopy
The most common tumors found within the mediastinum of ______ are neurogenic tumors. In ______ , thymomas and
lymphomas appear most frequently.
Children; adults
_____-______ ______ surgery is used for the diagnosis and treatment of several thoracic diseases and disorders of the esophagus, lungs, mediastinum, pericardium, and pleura.
Video-Assisted Thoracic Surgery (VATS)
What surgical procedure involves placing a bar to repair the most common congenital deformity of the chest ( a funnel-shaped, asymmetrical depression due to a posterior displacement of the sternal body)
The deformity usually affects 4 to 5 ribs on each side of the sternum. In extreme cases, the sternum may even reach the vertebral column.
It’s fixed by
Nuss Pectus Excavatum Repair by VATS
What is atelectasis?
Collapsed lung
________ embolism obstructs the pulmonary artery, resulting in life-threatening chronic pulmonary hypertension and its associated complications.
Pulmonary
A fibrin layer of blood and pus from a chest injury that’s not properly drained from the pleural cavity that forms over the parietal and visceral pleura and interferes with the proper expansion of the lung, is called:
empyema
The main goal of decortation of the lung is restore normal _____ function
Lung
Injury to the _____ nerve is avoided in order to prevent the paralysis of the diaphragm in a decortation of the lung
Phrenic
An Upper Lobectomy is the surgical removal of _____ tissue
Lung
A pneumonectomy is the surgical removal of a
Lung
The ___________ of the heart protects the heart and prevents it from rubbing against the thoracic cavity wall.
pericardium
The pericardium consists of two parts:
• _______ pericardium: outer layer of the pericardium, consists of white fibrous connective tissue, fits loosely around the heart and attaches to large blood vessels but does not attach to the heart itself
• _______ pericardium: the parietal layer lines the inside of the fibrous pericardium, the visceral layer is attached to the surface of the heart, and the pericardial space is the space between the two layers that contains pericardial fluid which acts as a lubricant
Fibrous; serous
The pericardium consists of two parts:
• _______ pericardium: outer layer of the pericardium, consists of white fibrous connective tissue, fits loosely around the heart and attaches to large blood vessels but does not attach to the heart itself
• _______ pericardium: the parietal layer lines the inside of the fibrous pericardium, the visceral layer is attached to the surface of the heart, and the pericardial space is the space between the two layers that contains pericardial fluid which acts as a lubricant
Fibrous; serous
The wall of the heart is composed of three layers:
- The ________, which is the outer layer of the heart, provides protection and is composed of the visceral pericardium.
- The ______ , which makes up the bulk of the heart wall, is composed of specially constructed cardiac muscle cells that contract and force blood from the heart’s chambers.
- The _______, which is the inner lining of the heart wall, lines all of the heart’s chambers and valves. It is composed of endothelial tissue, which consists of a single layer of flattened cells.
Epicardium, myocardium, endocardium
The heart has four chambers: ___ atria and ____ ventrices.
The ___ are the upper chambers and the ______ are the
lower chambers.
two; two
atria; ventricles
_____ (plural) / ____ (single)
• Receive blood from the veins of the body.
• Have walls thinner than those of the ventricles.
• Are divided by the interatrial septum.
Atria (plural) / atrium (single)
______
• Pump blood into the arteries leading away from heart.
• Have a thicker myocardium than do atria.
• The right pumps blood to the lungs.
• The left pumps blood into arteries that transport blood to all other regions of the body.
• Are divided by the interventricular septum.
Ventricles
_______ __________ (AV valve): Located between each atrium and ventricle
Atrioventricular valve
The _____ valve is located between the right atrium and the right ventricle. It is named for its three leaflike cusps.
Tricuspid
The blood exits the right ventricle through the __________ valve (Formed by three half-moon-shaped cusps), into the pulmonary artery to be transported to the lungs for oxygenation.
semilunar
Is also called bicuspid valve because it has two cusps. Blood flows from the left atrium, to this valve and into the left ventricle.
Mitral valve
A pathological condition that can occur is mitral valve _______. The valve does not close, allowing blood to backflow into the atrium.
regurgitation
Located at the base of the aorta. When the left ventricle contracts, this valve opens, allowing blood to flow into the aorta
Aortic semilunar valve
________ tendineae
These fibrous cords are attached to the cusps of valves on the ventricle side and prevent the cusps of the valve from folding back into the atrium, which would cause incomplete closure of the valve and lead to regurgitation of the blood back into the atrium.
Chordae
Blood flow through the heart: (put in order)
• Right atrium
• Vena Cavas (inferior and superior)
• Tricuspid valve
• Lung
• Left atrium
• aortic semilunar valve
• Pulmonary semilunar valve
• Right ventricle
• Left ventricle
• Pulmonary artery
• Alveoli
• Mitral valve
• pulmonary veins
• Aorta
- Vena Cavas (inferior and superior)
- Right atrium
- Tricuspid valve
- Right ventricle
- Pulmonary semilunar valve
- Pulmonary artery
- Lung
- Alveoli
- pulmonary veins
- Left atrium
- Mitral valve
- Left ventricle
- aortic semilunar valve
- Aorta
A procedure performed to create a new route for the blood going into the heart due to various pathologies is called:
Coronary Artery Bypass with Grafting (CABG)
As blood escapes from the ventricle into the pericardial sac, the heart is compressed, interrupting normal rhythm.
This potentially lethal condition is known as cardiac ______ and is usually treated by pericardiocentesis
Tamponade
A _____-_____ pulmonary artery catheter that indirectly measures left atrial and left
ventricular pressures by assessing right atrial, right ventricular, and pulmonary artery wedge pressures.
Swan-Ganz
This procedure uses two small incisions between the ribs on the left side of the chest to access the heart. A harvested artery is stitched to the coronary arteries.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
A coronary artery revascularization that is performed on a beating heart
Off-Pump Coronary Artery Bypass (OPCAB)
For patients who need cardiac support because they are waiting for cardiac transplantation or cannot be weaned from CPB.
Insertion of the balloon pump may increase cardiac output to a level that would permit separation from the pump oxygenator and allow time for the heart to recover.
Intra-aortic Balloon Pump (IABP)
Insertion of a _____ is performed for two reasons:
- Serve as a temporary device that maintains circulation in patients who need a heart transplant.
- Temporarily support an open-heart patient who cannot yet be removed from the СРВ.
Ventricular Assist Device (VAD) Insertion
Transplantation of a donor heart into a recipient is a ______ ____ ______.
Orthotopic Heart Transplant
_____________ is a general term designating primary disease of the myocardium, often of obscure and unknown etiology. In response to injury, the heart often enlarges, restricting its normal function.
Cardiomyopathy
_______ cardiomyopathy may occur in the individual who consumes large amounts of ethanol over a long period.
Ethanol has a toxic effect on cardiac tissue, and eventually results in cardiac enlargement and low cardiac output.
Alcoholic
_________ cardiomyopathy is characterized by cardiac enlargement, especially of the left ventricle, myocardial dysfunction, and congestive heart failure.
Congestive
_______ cardiomyopathy is characterized by an extensive thickening of the left ventricular myocardium and septum.
Blood flow from the atria to the ventricles may be affected as well.
Hypertrophic
________ cardiomyopathy results in the deposition of abnormal substances in the myocardium, as may occur in amyloidosis.
The foreign material results in restrictive cardiomyopathy because the heart cannot expand adequately to receive the inflowing blood.
Infiltrative
Surgical repair of localized dilation of walls of an artery due to structural weakening
Ventricular Aneurysm Repair
An _______ is a sac formed by localized dilatation of the walls of an artery due to
structural weakening.
The strength of an arterial wall is in the elastic tissue of the ______ _____.
Destruction of this layer by any disease diminishes the strength of the vessel wall.
aneurysm; tunica media
There are are two types of aneurysm:
_____ aneurysm, in which the wall of the sac consists of one or more of the layers that make up the wall of the blood vessel
_____, or pseudoaneurysms, which are pulsatile hematomas that are not contained by the vessel layers but are confined by a fibrous capsule.
True; False
Disease of the semilunar or AV valves of the heart can lead to:
• stenosis of the valves, a condition that can obstruct the normal flow of blood from one region of the heart to another
• valvular insufficiency, which can cause a reflux of blood into the area from which the blood was ejected during systole.
This reverse flow, usually involving the mitral and tricuspid valves is known as:
Regurgitation
Replacement of semilunar or AV valves due to pathologies caused by effects of rheumatic fever
Aortic valve replacement
An ____ ____ _____ (ASD) is an abnormal opening in the wall between the two atria.
There are three types of
ASD: ostium secundum, sinus venosus, and ostium primum.
Atrial septal defect (ASD)
A type of Atrial Septal Defect: The _______ ______ type is in the midatrial septum and is the most common.
ostium secundum
ASD type: The _____ _____ type of defect occurs high in the septum near the entrance of the superior vena cava in the right atrium.
This type of defect is usually associated with anomalous pulmonary venous drainage, in which one or more pulmonary veins drain into the right atrium rather than the left.
sinus venous
ASD type: The _____ ____ is located low in the anterior portion of the septum and is associated with other defects in the
AV canal, usually with a cleft of the mitral valve.
ostium primum
The surgical repair of abnormal opening in the wall between two atria.
A Dacron patch is used to repair the defect
Repair of Atrial Septal Defect (ASD)
____ _____ _____ (PDA), is a failure of this fetal structure to completely close after birth.
Patent Ductus Arteriosus (PDA)
Repair of congenital defect in which natural closure of connection does not occur in the ductus arteriosus in fetal life
Closure of Patent Ductus Arteriosus (PDA)
_______ of the aorta is a localized narrowing of the aorta in an otherwise normal vessel.
Coarctation
Surgical repair of localized stricture of the aorta
Repair of Coarctation of the Aorta
____ of _____ of ____ (TOF) is the most common cyanotic heart defect in children.
The classic form, of which there are several variations, includes the following four defects:
Congenital:
1. VSD
2. Infundibular or pulmonary valve stenosis
3. An aorta that overrides the VSD
Acquired (as a result of the increased pressure within the right ventricle):
4. Right ventricular hypertrophy
Repair of Tetralogy of Fallot (TOF)
“Blue babies” procedure
Repair of Tetralogy of Fallot (TOF)
