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Contents 1. Anatomy 1 Fritz J. Baumgartner Chambers 1 The Conduction System 4 The Cardiac Valves 4 Coronary Arteries 7 2. Cardiac Diagnosis 9 Matthew Budoff, Fritz J. Baumgartner and Bassam O. Omari Echocardiography 9 Radionuclide Imaging 11 Cardiac Catheterization 12 CT Cardiac Imaging 15 Coronary Artery Calcification and Atherosclerosis 16 Noninvasive Angiography 16 Spiral CT 16 Magnetic Resonance Imaging (MRI) 17 3. Cardiopulmonary Bypass and Myocardial Protection 19 Fritz J. Baumgartner General Principles 19 Cardioplegia 20 Technique 22 Femoral-Femoral Bypass 24 Left Atrial-Femoral Bypass 25 Intra-Aortic Balloon Pump 25 Pathophysiology of Cardiopulmonary Bypass 26 Autologous Transfusion 27 pH and CO2 Monitoring on CPB 28 Air Embolus 28 Cardiopulmonary Bypass During Pregnancy 29 Sickle Cell Anemia 29 Cardiopulmonary Bypass in Chronic Renal Disease 30 CNS Injury in Surgery of the Descending Aorta 30 Intraoperative Heart Failure 31 Venovenous Bypass 32 4. Cardiothoracic Anesthesia 37 John R. Charney Monitoring 37 Mixed Venous Oxygen Saturation 37 Right Ventricular Ejection Fraction (RVEF) 38 Transesophageal Echocardiography (TEE) 38 Properties of Ultrasound 38 Doppler Flow 39 Color Flow Doppler 39 2-Dimensional Imaging 40 Anesthetic Agents 41 Synthetic Opiates 41 Inhalational Agents 41 Other Anesthetics 42 Muscle Relaxants 43 Coagulation 45 Thoracic Anesthesia 47 5. Coronary Artery Disease 51 Fritz J. Baumgartner and Matthew Budoff Evaluation of the Coronary Patient 51 Untreated Survival 52 Unstable Angina 52 Percutaneous Transcoronary Angioplasty (PTCA) 53 Coronary Bypass Surgery 55 Ischemic Ventricular Septal Defect and Mitral Regurgitation 62 Combined Carotid and Coronary Artery Disease 67 Ischemic and Nonischemic Ventricular Tachycardia 68 6. Valvular Heart Disease 71 Fritz J. Baumgartner Aortic Valve Disease 71 Mitral Valve Disease 76 Tricuspid Valve Disease 87 Mechanical and Bioprosthetic Cardiac Valves 91 Techniques of Combined Valve Procedures 96 Endocarditis 97 Aortic Allograft and Autograft Procedures 98 7. Aortic Aneurysm/Dissections/Ruptures 105 Fritz J. Baumgartner General Classification 105 Aortic Dissection 105 Thoracic Aortic Aneurysms 116 Traumatic Aortic Rupture 125 8. Hypertrophic Obstructive Cardiomyopathy 129 Bassam O. Omari, Fritz J. Baumgartner Hypertrophic Obstructive Cardiomyopathy 129 Cardiac Tumors 130 9. Minimally Invasive Heart Surgery 133 Fritz J. Baumgartner "Minimally Invasive" Valve Surgery 134 MIDCAB 135 OPCAB 137 Thoracotomy for Obtuse Marginal OPCAB 140 10. ICU Management 143 Fritz J. Baumgartner, John R. Robertson, Bassam O. Omari Physiology 143 Postoperative Protocols at Harbor-UCLA 147 11. General Thoracic Anatomy 167 Fritz J. Baumgartner Surface Anatomy of the Lungs 167 Bronchopulmonary Segments 167 The Bronchial Tree 167 Pulmonary Arterial System 170 Pulmonary Venous System 170 Bronchial Arteries and Veins 173 Lymphatic System 173 12. Lung Cancer 177 Fritz J. Baumgartner General 177 Nonsmall Cell Lung Cancer 177 Nonsmall Cell Carcinoma Staging 178 Small Cell Lung Cancer 180 Paraneoplastic Syndromes 181 The Approach to the Patient with a Lung Mass 182 Occult Cancer 185 Segmentectomy Versus Lobectomy 185 Radiation Therapy 186 N2 Disease 186 T3 Chest Wall Involvement 187 Superior Sulcus Tumors 187 Brain Metastases 189 Technical Considerations 189 13. Empyema 205 Fritz J. Baumgartner NonPost-resection Empyema 205 Post-resection Empyema 207 14. Tuberculosis 211 Fritz J. Baumgartner Pulmonary Tuberculosis 211 Thoracoplasty 213 Massive Hemoptysis 213 15. Chest Wall Tumors 215 Fritz J. Baumgartner 16. Mesothelioma 219 Fritz J. Baumgartner 17. Esophagus 221 Fritz J. Baumgartner Anatomy 221 Esophageal Neoplasia 223 Esophageal Carcinoma 224 Malignant Tumors of the Lower Third of the Esophagus 225 Malignant Tumors of the Middle Third of the Esophagus 227 Malignant Tumors of the Proximal Third of the Esophagus 228 Colonic/Jejunal Esophageal Replacement 230 Unresectable Esophageal Cancer 231 Hiatal Hernia and Gastroesophageal Reflux 231 Motility Disorders 234 18. Mediastinal Masses 237 Fritz J. Baumgartner Anterior Mediastinum 237 Myasthenia Gravis and Thymoma 239 Middle Mediastinum 241 Posterior Mediastinum 241 19. Thoracic Trauma 245 Fritz J. Baumgartner Airway Obstruction 246 Tension Pneumothorax 246 Open Pneumothorax 247 Hemothorax 247 Flail Chest 247 Cardiac Tamponade 248 Aortic Rupture 250 Tracheobronchial Injuries 252 Esophageal Trauma 255 Pulmonary Contusion 256 Myocardial Contusion 256 Traumatic Diaphragm Rupture 256 Bony Chest Fractures 256 Injuries to the Cardiac Valves and Coronary Arteries 257 Transmediastinal Gunshot Wounds 257 Combined Chest, Abdominal and Head Trauma 257 20. Congenital Causes of Respiratory Distress 263 Fritz J. Baumgartner 21. Chest Wall Congenital Deformities 267 Fritz J. Baumgartner 22. Thoracic Outlet Syndrome, Hyperhidrosis and Causalgia 269 Fritz J. Baumgartner General Characteristics of Thoracic Outlet Syndrome 269 Provocative Maneuvers 269 Costoclavicular Test (Military Position) 271 Roos Test 271 Transaxillary First Rib Resection 272 Causalgia 272 Hyperhydrosis 273 23. Pulmonary Mechanics 275 Fritz J. Baumgartner 24. Surgery of the Trachea 279 Fritz J. Baumgartner Anatomy 279 Pathology 279 Surgical Treatment 280 Reconstruction of the Trachea 281 Tracheal Innominate Fistula 284 Tracheoesophageal Fistula 285 25. Thoracoscopy 289 Fritz J. Baumgartner General Principles 289 Apical Bleb Resection 291 Lung Biopsy 292 Cancer Staging and Lymph Node Biopsy 293 Dorsal Sympathectomy 293 Esophagomyotomy 294 Index 297
Library of Congress Subject Headings for this publication: Heart Surgery, Chest Surgery, Cardiac Surgical Procedures methods, Thoracic Surgical Procedures methods