59 Cardiac surgery

ACKNOWLEDGEMENTS The author and editors wish to acknowledge the help of Mr Nathan Tyson in the p...

ARREST AFTER CARDIAC SURGERY Introduction The incidence of cardiac arrest after cardiac surgery i...

Acyanotic congenital heart disease Patent ductus arteriosus The ductus arteriosus, a normal feta...

Aetiology There is often no obvious aetiology; most abnormalities appear to be multifactorial wit...

Aortic dissection This occurs when a defect or flap occurs in the intima of the aorta, resulting i...

Aortic valve disease Approximately two-thirds of all valve surgery performed in the UK is for ao...

C A R D I A C M A S S E S Cardiac masses can be either thrombus (blood clots) or tumours. Thromb...

CARDIOPULMONARY BYPASS CPB was first used successfully in 1953 by Gibbon and has since - revolutio...

CONGENITAL HEART DISEASE Introduction Congenital heart diseases are abnormalities of cardiac str...

CORONARY ARTERY BYPASS SURGERY

Cardiac arrest with ‘non-shockable’ rhythm Cardiac surgical patients with a non-VF/ventricular ta...

Cardiopulmonary bypass circuit Once the circuit is connected ( Figure 59.1 ) the CPB machine (‘pu...

Classification Congenital heart disease can be broadly classified according to the presence or abse...

Clinical manifestations The principal symptoms of IHD are chest pain or angina, breathlessness, ...

Complications of CPB CPB is a complex technique requiring careful interaction and communication b...

Coronary artery anatomy The coronary arteries are branches of the ascending aorta, arising from ...

Development of the heart and fetal

Diagnosis Antenatal diagnosis is occasionally possible, with severe defects detected in utero at ...

Emergency resternotomy for ventricular fibrillation or pulseless ventricular tachycardia A precord...

Emergency resternotomy After the identification of cardiac arrest, basic life support according t...

FURTHER READING Bojar RM. Manual of perioperative care in cardiac surgery , 5th edn. Ox - ford: ...

HISTORICAL PERSPECTIVE Prior to 1925, when Sir Henry Souttar reported the first mitral commissurot...

Incidence Cardiac defects are the most common congenital abnormalities in the UK; the incidence o...

Indications for surgery The decision to o ff er CABG is based on the balance between expected bene...

Initiating cardiopulmonary bypass Arterial cannulation Conventionally , a perfusion cannula is in...

INTRODUCTION Cardiac surgery has developed at a rapid pace since the first procedures in the 1920s...

Investigations Non-invasive methods of diagnosis Resting electrocardiography As a baseline test, ...

Ischaemic heart disease IHD is a major cause of morbidity and mortality in resource- rich countri...

Learning objectives To provide an overall view of: The principles of cardiopulmonary bypass • Inc...

Mitral valve disease Mitral regurgitation Any pathological process a ff ecting the mitral valve a...

Myocardial protection Once CPB has been established, the ascending aorta is usually cross-clamped...

Outcomes If type A dissection is untreated, the mortality rate is 50% within 48 hours and 75% wi...

PERICARDIAL DISEASES There is a fibrous envelope covering the heart and separating it from the med...

Pericardial effusion There is continuous production and resorption of pericardial fluid; if this...

Pericarditis Infection and inflammation may also a ff ect the pericardium. Acute pericarditis usual...

Postoperative complications Bleeding Significant bleeding occurs in approximately 2–3% of patients...

Postoperative management Antibiotic prophylaxis Currently the National Institute for Health and C...

Postoperative recovery The majority of patients are extubated a few hours postoper atively and r...

Preparation for surgery Clinical assessment Before CABG, the severity and stability of the patie...

Primary malignant cardiac tumours These are extremely rare and less common than secondary maligna...

Prosthetic valve dysfunction and complications Structural valve failure Structural failure rates ...

Rhabdomyoma Cardiac tumours in children are incredibly rare (<0.2% of the population), although t...

Selection of conduit Venous grafts The long saphenous vein is the most commonly used venous cond...

Surgical anatomy Heart valves serve to maintain pressure gradients between cardiac chambers, thus...

Surgical approach to the heart Median sternotomy is the main approach during cardiac surgery . An...

Surgical options Type A (or type I and II) dissections Those involving the ascending aorta usuall...

Surgical outcome Relief of symptoms If revascularisation is complete, CABG alleviates or improve...

THE THORACIC AORTA The most common pathologies a ff ecting the thoracic aorta are aneurysm forma...

The operation Intraoperative monitoring includes continuous central venous pressure and blood pre...

Thoracic aortic aneurysms A true aneurysm is a localised dilatation of a blood vessel involving ...

Types of prosthetic valves Mechanical valves Mechanical valves can be used in any age group to re...

VALVULAR HEART DISEASE Introduction Early surgical management of valvular heart disease concen -...

Venous cannulation A single purse-string suture is placed around the right atrial appendage and a...

circulation and circulatory changes at birth By 12 weeks of fetal life the primitive vascular t...