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Diagnosis Antenatal diagnosis is occasionally possible, with severe defects detected in utero at 16–18 weeks. If an infant has suspected congenital heart disease, a diagnostic evaluation begins with an accurate history from the parents and specific questions a...

Emergency resternotomy for ventricular fibrillation or pulseless ventricular tachycardia A precordial thump may be successful if performed within 10 seconds of the onset of VF or pulseless VT; however, this should not delay cardioversion by defibrillation. In V...

Emergency resternotomy After the identification of cardiac arrest, basic life support according to the Advanced Life Support guidelines should be initiated while preparing for emergency resternotomy . Emergency resternotomy may be required in 0.8–2.7% of all ...

FURTHER READING Bojar RM. Manual of perioperative care in cardiac surgery , 5th edn. Ox - ford: Wiley-Blackwell, 2010. Cohn LH. Cardiac surgery in the adult , 5th edn. New Y ork: McGraw Hill Professional, 2017. Dunning J, Fabbri A, Kolh PH et al . Guideline f...

HISTORICAL PERSPECTIVE Prior to 1925, when Sir Henry Souttar reported the first mitral commissurotomy in the British Medical Journal , heart surgery was thought to be impossible. Souttar wrote that the heart should be as amenable to surgery as any other organ, ...

Incidence Cardiac defects are the most common congenital abnormalities in the UK; the incidence of significant cardiac abnormalities is 8 per 1000 live births. Many spontaneous abortions or stillbirths have cardiac malformations or chromosomal abnor malities a...

Indications for surgery The decision to o ff er CABG is based on the balance between expected benefit and potential risks to the patient. Two issues need to be addressed when determining surgical suitability: the appropriateness of revascularisation and the rel...

Initiating cardiopulmonary bypass Arterial cannulation Conventionally , a perfusion cannula is inserted into the ascend ing aorta. Two purse-string sutures are usually placed in the selected area for cannulation after manual or epiaortic scan inspection to ens...

INTRODUCTION Cardiac surgery has developed at a rapid pace since the first procedures in the 1920s. Driven by trauma innovations during the post-war period, the specialty has seen a massive expansion in the range and complexity of conditions treated. Initially...

Investigations Non-invasive methods of diagnosis Resting electrocardiography As a baseline test, a 12-lead resting electrocardiogram (ECG) often provides the first indication of ischaemic cardiac disease and is essential in the acute clinical setting. However,...

Ischaemic heart disease IHD is a major cause of morbidity and mortality in resource- rich countries. The underlying pathology is usually atheroscle - rosis of the coronary arteries. Pathophysiology Atherosclerosis is the process underlying the formation of f...

Learning objectives To provide an overall view of: The principles of cardiopulmonary bypass • Incisions, conduits and valve options in cardiac surgery • The role of investigation and preoperative assessment in • planning surgery The management of coronary hear...

Mitral valve disease Mitral regurgitation Any pathological process a ff ecting the mitral valve apparatus may lead to mitral regurgitation. As such, there are many causes of regurgitation and they can be broadly classified into four headings. They are shown in...

Myocardial protection Once CPB has been established, the ascending aorta is usually cross-clamped to obtain a bloodless operative field. The heart ceases ejecting and becomes anoxic owing to inhibition of coro - nary blood flow . Permanent myocardial damage can...

Outcomes If type A dissection is untreated, the mortality rate is 50% within 48 hours and 75% within 1–2 weeks, whereas patients with type B dissections have a better prognosis. Surgical mortality is variable but is around 20–25% for proximal aortic dissectio...

PERICARDIAL DISEASES There is a fibrous envelope covering the heart and separating it from the mediastinal structures. This includes a parietal layer and allows the heart to move with each beat. It can be left wide open after cardiac surgery without any ill e ff...

Pericardial effusion There is continuous production and resorption of pericardial fluid; if this balance is disturbed, a pericardial e ff usion may develop. If the pressure exceeds the pressure in the atria, compression will result in reduced venous return an...

Pericarditis Infection and inflammation may also a ff ect the pericardium. Acute pericarditis usually occurs following a viral illness. Treat ment is with non-steroidal anti-inflammatory drugs and bed rest (in case there is an underlying myocarditis). Acute purul...