STS E Book - Cardiac Anatomy Flashcards
What is the visceral epicardium?
Makes contact with the heart.
May be a separate layer in bad restrictive pericarditis that needs to be peeled off separately once pericardium is entered.
What is the acute margin in terms of cardiac border anatomy?
Inferior edge, creates the angle between the sternocostal surface and the diaphragmatic surface.
What ribs cover the heart?
3rd, 4th, and 5th.
Where is the phrenic nerve in the thoracic inlet?
Just posterior to the IMA. They run on the anterior surface of the anterior scalene muscle.
What is the right phrenic nerve’s course after the thoracic inlet? When might it be injured in heart surgery?
It lies on the lateral surface of the SVC, in harm’s way during dissection for venous cannulation for CPB.
Or during RIMA dissection.
What does the right recurrent laryngeal nerve pass around?
R SC artery. Ascends in the TE groove.
Excessive dissection of the SC arteries (eg during shunt procedures) can damage what? Causing what pathology?
The subclavian loop, which carries fibers from the stellate ganglion to the eye and head. Damage here can cause Horner’s syndrome.
Where are the phrenic and vagus nerves in relation to the pulmonary hilum?
Phrenic is anterior. Vagus is posterior.
Describe a midline sternotomy.
Skin incision from the jugular notch to the xiphoid. Bovie to the presternal fascia and expose the periostium. Divide the sternum midline with a saw. Hemostasis. Sternal spreader. Divide the thymic fat pad to the brachiocephalic (innominate) vein. Open the pericardium.
How can you extend a sternotomy incision to expose the branches of the aortic arch?
Extend the incision onto the neck along the anterior border of the SCM.
How can you extend a median sternotomy to expose the proximal descending thoracic aorta?
Perpendicular extension of the incision through the third intercostal space.
What incision is used for double lung and heart-lung transplants?
Bilateral transverse thoracosternotomy (ie clam shell incision) through the 4th or 5th interspace.
What non-sternotomy and non-clam shell incision can be made to access the R heart; tricuspid, and mitral valves; and R coronary?
R anterolateral thoracotomy. Can be used for Blalock-Hanlon atrial septectomy, or for valvular replacement after previous sternotomy.
To access the distal aortic arch and descending aorta, what incision can be made?
Left posterolateral thoracotomy. CPB cannulation must be done through femoral.
