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Ultrasonography Ultrasonography is the primary imaging modality in young women with dense breast tissue in whom mammograms are di ffi cult to interpret. Ultrasonography can distinguish cystic from solid lesions. Simple cysts do not require further work-up and fo...

Vacuum-assisted biopsy The sampling error decreases as the biopsy volume increases and using 8G or 11G needles allows more extensive biopsies to be taken. This is useful in the management of microcalcifi - cations and removal of benign lumps such as fibroadenom...

Work-up for metastatic breast cancer Contrast-enhanced CT of the chest, abdomen and pelvis and an isotope bone scan are needed for patients with locally advanced breast cancer (T3, T4 or N2, N3 disease). Patients with early breast carcinoma (T1, T2 and N0, N1...

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

ARREST AFTER CARDIAC SURGERY Introduction The incidence of cardiac arrest after cardiac surgery is around 0.7–8.0%, with 17–79% survival rates. VF accounts for up to 50% of arrests; tamponade and major bleeding account for most others. Multiple variables may ...

Acyanotic congenital heart disease Patent ductus arteriosus The ductus arteriosus, a normal fetal communication, facilitates the shunting of oxygenated blood from the pulmonary artery to the aorta, away from the lungs. Normally , functional closure of the d...

Aetiology There is often no obvious aetiology; most abnormalities appear to be multifactorial with both genetic and environmental influ ences. There are well-recognised associations. Jacqueline Anne Noonan , 1928–2020, pediatric cardiologist, the University of ...

Aortic dissection This occurs when a defect or flap occurs in the intima of the aorta, resulting in blood tracking into the aortic tissues, splitting the medial layer and creating a false lumen. It most commonly occurs in the ascending aorta or, less often, jus...

Aortic valve disease Approximately two-thirds of all valve surgery performed in the UK is for aortic valve disease, which remains common despite rich countries. - Aortic stenosis The commonest cause of aortic stenosis in adults is an acquired, degenerative, ...

C A R D I A C M A S S E S Cardiac masses can be either thrombus (blood clots) or tumours. Thrombus can be found in patients with poor left ventricular function or longstanding AF , as well as in patients with proximal pulmonary embolus, in either the ventricl...

CARDIOPULMONARY BYPASS CPB was first used successfully in 1953 by Gibbon and has since - revolutionised cardiac surgery . It can be used in any procedure in which the heart and lungs need to be stopped temporarily and their function replaced artificially . Befor...

CONGENITAL HEART DISEASE Introduction Congenital heart diseases are abnormalities of cardiac struc - ture that are present from birth. Such developmental abnor - malities of the heart typically arise in the third to eighth week - of gestation. The first opera...

CORONARY ARTERY BYPASS SURGERY

Cardiac arrest with ‘non-shockable’ rhythm Cardiac surgical patients with a non-VF/ventricular tachycar dia (VT) arrest commonly have tamponade, tension pneumo thorax or severe hypovolaemia. Prompt treatment is associated with an excellent outcome. Resternotom...

Cardiopulmonary bypass circuit Once the circuit is connected ( Figure 59.1 ) the CPB machine (‘pump’) gradually takes over circulation and ventilation. Once - tion or full flow is established (the required cardiac output depends on many factors, including the p...

Classification Congenital heart disease can be broadly classified according to the presence or absence of cyanosis, although the distinction is not always clear-cut. Central cyanosis – blueness of the trunk and mucous membranes – results from levels of deoxyg...

Clinical manifestations The principal symptoms of IHD are chest pain or angina, breathlessness, fatigue, peripheral oedema, palpitations and syncope. The severity of symptoms and the extent to which the symptoms interfere with everyday activities and quality...

Complications of CPB CPB is a complex technique requiring careful interaction and communication between surgeon, anaesthetist and perfusionist to ensure patient safety . Di ffi culties can occur during cannu lation (aortic dissection or atrial injury), at the st...