Theory: Cardiothoracic exam

What is the cause of aortic valve regurgitation

Valvular insufficiency causing reverse flow involving the mitral and tricuspid valve

How is a sphenous vein prepared for a CABG

Vein is flushed with heprinized saline to identify any branches that may have been missed then stored in a heparin/saline solution until needed

-used to support the circulation from the left, right, or both ventricles -for patients who require a heart transplant -decreases work load of the heart by diverting blood from the ventricle to a pump the pushes the blood

Ventricular assist device (VAD)

-an abnormal opening in the wall between the right and left ventricle -symptoms may not occur until several weeks after birth

Ventricular defect

Where is the heart located

Within the mediastinum with two thirds of the organ on the left side

Where do the coronary arteries arise from?

Ascending aorta

Where does the trachea divide

At the carina

-An abnormal opening in the wall between two atria -three types: ostium Secundum, sinus venousus, ostium primum

Atrial septal defect

Valve located between each atrium and ventricle

Atrioventricular valve (AV)

Areas of over distension in lung tissue

Blebs

-congenital defect -failure of the this fetal structure to completely close after birth -connects pulmonary artery to the aorta in order to shunt oxygenated blood directly into the systemic circulation by bypassing the lungs

Ductus arteriosus

Normal fetal structure that allows blood to bypass circulation to the lungs, if this structure remains open after birth it is called patent ductus arteriosus

Ductus arteriosus

A pus filled area of the lung

Empyema

-inner layer of the heart -lines all the hearts chambers and valves -composed of endothelial tissues, consists of single layer of flattened cells

Endocardium

-outer layer of the heart -provides protection -is composed of the visceral pericardium

Epicardium

-located in surrounding tissue -sac outside a vessel

False aneurysm

-outer layer of pericardium -consists of fibrous connective tissue -fits loosely around the heart and attaches to large blood vessels but does not attach to heart itself -inelastic -protects the heart

Fibrous pericardium

Which intercostal space is entered for a thoracotomy

Fifth or sixth

What instrument is preferred for removing a foreign body in the bronchial tree of infants and children

Flexible bronchiscope

What protects the heart and prevents it from rubbing against the thoracic cavity wall

Pericardium

An increase in fluid (such as serous fluid, pus or blood)

Pleural effusion

Air in the lungs

Pneumothorax

The thoractomy procedure has a ______________ incision

Posterolater

Position for repair of coarctation

Posterolateral

What position is the patient in for a lobectomy

Posterolateral

What happens if there is nerve damage during a lung decortication

Potential paralysis of the diaphragm

Congenital deformity of the chest wall most commonly resulting in protrusion of the upper sternum and depression of the lower anterolateral chest wall

Precuts carnatum

Funnel shaped, asymmetrical depression due to a posterior displacement of the sternal body

Precuts excavactum

What is used to repair ASD and VSD in pediatric patients

Prosthetic patch materials or pericardial pieces

-formed by three half mooned shaped cusps -blood enters the right ventricle through semilunar valve into the pulmonary artery to be transported to lungs for oxygenation

Pulmonary semilunar valve

What thoracic procedures require the patient to be put on CPB

Pulmonary thromboendarterectomy, double lung transplant

-aka heart lung machine -apparatus used in cardiac surgery to remove unoxygenated blood from the venous system, oxygenate and filter it

Pump oxygenator

What suture technique is used for CPB cannulation

Purse string suture technique

What is the cause of aortic valve stenosis

Rheumatic disease, acute infection, atheroserotic heart disease or congenital defects

Where does cannula go during CABG procedure?

Right atrium/vena cava for deoxygenated blood, aorta for oxygenated blood

What cyanotic defects are acquired

Right ventricular hypertrophy

-has three layers -parietal layer, visceral layer, pericardial space

Serous pericardium

-has three layers -parietal layer: lines the inside of of the fibrous pericardium -visceral layer: attached to the surface of the heart -pericardial layer: space between the two layers that contain pericardial fluid

Serous pericardium

What suture is used for the closure of a median sternotomy

Size 0 polyester suture

What devices are used in off pump CABG procedures

Special loop suture, specially designed stabilizers, site blower to remove blood from surgical site

What grafts are used for a CABG procedure

Sphenous graft, left internal mammary artery (LIMA), radial artery

What vein is harvested for a CABG anastomoses

Sphenous vein graft

__________ ______________ _____________ is used to close the median sternotomy

Stainless steel wire

What. Cyanotic defects are congenital

VSD, infundibulaar or pulmonary valve stenosis, an aorta overrides the VSD

What are the four cyanotic defects

VSD, unfindubular or pulmonary valve stenosis, an aorta that overrides the VSD, right ventricular hypertrophy

During defecation, the glottis is voluntarily closed and the intraabdominal muscles are contracted

Valsalva maneuver

How many pulmonary veins are there

four

-located at the base of the aorta -when left ventricle contracts, the valve opens allowing blood to flow from the aorta

Aortic semilunar valve

What instruments are used for an arteriotomy

#11 blade, 45* Potts smith scissors for expansion

Describe how blood flows through the heart

1. The rigth atrium recives deoxygenated blood from the superior vena cava, inferior vena cava, and coronary sinus 2. Tricuspid valve opens allowing blood to flow into the right ventricle then closes 3. Pulmonary semilunar valve opens and blood enters the pulmonary artery and travels to the lungs for oxygenation, right ventricle relaxes to close valve 4. Oxygenated blood returns to the heart through four pulmonary veins and enters the left atrium 5. Atrial wall contracts, mitral valve opens, blood enters the left ventricle 6. Left ventricle contracts, mitral valve closes, aortic semilunar valve opens, blood enters aorta for transport to the rest of the body

What is the lifespan of a biological/mechanical mixed heart valve replacement

10-15 years

What is normal adult blood pressure

120/80

How many lobes in the left lung

2 lobes

How many layers does the heart have

3

How many lobes in the right lung

3 lobes

What suture Is used for CABG graft anastomoses

6-0 or 7-0 gauge polypropylene suture

What is the normal adult heart rate

72 beats per minute

What diagnostic procedures determine the overall size of the heart

A+P and lateral x-rays

What aides in protecting the heart during CPB

Accomplished with systemic hypothermia, topical myocardial hypothermia, and the administration of cold potassium cardioplegia solution into the coronary arteries

What structure is between the alveoli and the bronchiole

Alveolar ducts

What is done additionally for pain control for patients undergoing pectus excavatum repair

An epidural catheter is inserted preoperativly

How is the sphenous vein greft anastomosed

Anastomosed to the affected coronary artery with 6-0 or 7-0 gauge polypropylene suture

The process of placing a cannula into the right atrium or vena cava for draining venous blood to the pump oxygenator and the ascending aorta for the return of arterial blood from the pump oxygenator

Aortic cannulation for CPB

Where is the swan ganz catheter inserted

Arteries leading towards the lungs

What hemostatic agents are used with a median sternotomy

Bone wax or ESU

-only electrical connection between the atria and ventricles -enters upper portion of interventricular septum and divides into left and right bundle branches that travel along the septum into the apex

Bundle of HIS (AV node)

This scan is especially useful for the detection and evaluation of thoracic aorta dissection

CT scan

Useful for the evaluation of pericardial and intracardiac and extracardiac masses

CT scan and MRI

________________ _________________________ reveals the extent of the valvular insufficiency, the degree of ventricular overload, the stroke volume, and ejection fraction

Cardiac catheterization

The pumping action of the heart from one beat to the next

Cardiac cycle

As blood escapes from the ventricle into the pericardial sac, the heart is compressed, interrupting normal rhythm, this is potentially lethal

Cardiac tamponade

General term designating primary disease of the myocardium, often of obscure and unknown etiology

Cardiomyapothy

Diverts blood away from the heart and lungs so surgery can be performed

Cardiopulmonary bypass

What are some common complaints from patients with thoracic aortic aneurysms

Chest pain, trouble breathing, low blood pressure, shortness of breath

Which artery supplies blood to the walls of the left atrium and ventricle

Circumflex artery

Device used to restore negative pressure in the thoracic cavity when the chest wall and pleura are opened or punctured

Closed water seal drainage

-heart disease -most common type of coronary artery disease -risk factors include age, gender, race, genetics, hypertension, cigarette smoking, diet, obesity, clotting factors, psychological influences

Coronary atherosclerosis

Coronary veins empty into the

Coronary sinus

-may appear soon after birth, in infancy, or later in childhood -these "blue babies" may have episodes of rapid breathing and may even lose consciousness

Cyanotic defects

The phase of the heartbeat when the heart muscle relaxes

Diastole

What structure is involved with heart murmer

Heart valves

Blood in the lungs

Hemothorax

to spread into or invade a tissue or an organ

Infiltrate

How does an atheroma form

Injury to the endothelial lining of the arterial wall

Device that increases the supply of oxygen to the heart -reduces workload of the heart after MI or in patients who can not be taken off bypass -inserted through the descending aorta in retrograde direction via femoral artery -process is done under local anesthesia or at closure of cardiac surgery

Intra aortic balloon pump

What are the components of the heart lung machine

Intracardiac vent, venous drainage, venous reservoir and oxygenator, blood filter, roller pumps, cardiotomy reservoir, cardiotomy suckers

What is the most dangerous artery to have blocked

Left anterior descending artery

Which artery accounts for 50% of occlusive coronary lesions

Left anterior descending artery (LAD)

Can detect abnormal positioning of intracardiac structures

MRI

-Thymomas, lymphomas, and germ cell tumors -tend to be enterogenous cysts, lymphomas, neurologic tumors, and pleuropericardial cysts

Malignant lesions of the emediastinum

Identify the parts of the sternum

Manubrium, body, xiphoid process

-also called bicuspid valve -when left ventricle contracts, this closes -when it opens, allows blood to flow from left atrium to left ventricle

Mitral valve

-makes up the bulk of the heart wall -composed of specially constructed cardiac muscle cells that contract and force blood form the hearts chambers

Myocardium

The phase of the heartbeat when the heart muscle contracts

Systole

-common cyanotic heart defect in children -blue babies with sudden episodes of severe cyanosis with rapid breathing and may even lose consciousness -infants with severe condition may require a shunt between aorta and subclavian artery

Tetralogy of fallot (TOF)

What kind of biopsy is obtained from a bronchoscopy

Tissue and cytology biopsy

What kind of biopsy is obtained from a mediastinoscopy

Tissue specimen

-located between the right atrium and right ventricle -opens when blood pressure increases -named for three leaf like cusps

Tricuspid vavle

-sac within a vessel -types include saccular, fusiform, dissecting

True aneurysm

-incoorperated into suction apparatus by attaching it between suction tip and the suction tubing -must be maintained in upright position during specimen collection to prevent the fluid from entering the suction tubing

Use of likens tube