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Cardiothoracic Surgery

Sternum(thorax) anatomy

Superior to Inferior
-xiphoid process

12 Ribs

7 true ribs
Connected to the sternum by costal cartilage

Hyaline Cartilage (trachea)

C-shaped rings that prevent trachea from collapsing

Bronchial Division (trachea)

Bronchioles end in alveolar ducts(between the bronchioles


Microscopic air sacs clustered at the end of bronchioles

Hilam (lungs)

Slight concave portion on medial side of each lung where the bronchus

Main Bronchi

Pulmonary arteries


Oxyginated blood leaves the lungs through the pulmonary veins

Pulmonary Veins if the Lungs

-2 from right lobe
-2 from left lobe

Location of Heart

-located within the mediastinum
-2/3 of organ slightly on the left side

Fibrous Pericardium
-heart coverings

-surrounds the heart
-fits loosely around the heart

Parietal Layer
(serous pericardium)

Lines the inside of the fibrous pericardium

Visceral Layer
(serous pericardium)

attached to the surface of the heart

Pericardial Space
(serous pericardium)

Space between the 2 layers that contains pericardial fluid,which acts as a lubricant on the surfaces of 2 layers,reduces friction


Makes up the bulk of the heart wall

Mitral Valve

Also called the bucuspid valve

Chordae Tendineae

-these fibrous cords are attached to the cusps of valves on the ventricle side
-prevent the cusps of the valve from folding back into the atrium

Blood Flow Through the Heart

-rt ventricle pumps blood into pulmonary artery
-lt ventricle pumps to aorta

Circumflex Artery

Supplies blood to left ventricle

The Cardiac Cycle

-includes all physiological actions that occur during a SINGLE heartbeat
Systole:phase of contraction
Diastole:phase of relaxation

Cardiac Conduction

1. SA node
2. AV node
3. Bundle of His
4. Purkinje Fibers

72 beats per minute

Adult normal resting heart rate average

Sinotrial Node

SA node
-located in the right atrial wall inferior to opening of superior vena cava
-"pacemaker" of the heart

Atrioventricular Node

AV node
-impulses from SA node travel here
-the action potential shows at AV node because the fibers are smaller, thus allowing time for the atria to empty blood into the ventricles

Bundle of His (Atrioventricular bundle)

Only electrical current between the atria

Purkinje Fibers

Electrical impulses from Bundle of His enter these conduction fibers

Anatomical Develoment of the Heart

-development begins just before the end of the 3rd week of gestation

Ductis Venosus

A continuation of the umbilical vein

The Ductis Arteriosus

Connects the pulmonary artery with the descending thoracic aorta, allowing blood to enter fetal circulation w/out going through the lungs
-this structure closes at birth

Pectus Excavatum

-the most common congenital deformity of the chest
-a funnel-shaped,asymetrical depression due to a posterior displacement of the sternal body

Pectus Carinatum

Results in a prominant sternum

The Mediastinum

Symptomatic lesions are malignant in 60% of all patients

Carcinoma of the Lungs

-leading cause of death due to cancer in the U.S.
-in most cases, it is the result of smoking
-90% off all patients are cigerette smokers


Blunt or penetrating trauma may result in an accumilation of air

Cardiac Tamponade

-compression of the heart due to a collection of blood or fluid w/in tge pericardium
-usually the result of penetrating trauma

Cardiac Tamponade Treatment

-must be immediate
-pericardial aspiration through a small subxiphoid incision is 1st step
-must be ready for median sternotomy or thoracitomy in case pericardiocentesis results in massive blood loss


A sac formed by localized dilation of the walls of artery due to structural weakening

True Aneurysm

The wall of the sac consists of one or more of the layers that make up the wall of the blood vessel
**Atherosclerotic aneurysm

Thoacic Aortic Aneurysm

-chest pain is the cheif complaint
-may be asymptomatic

Spindle Shaped Aneurysm

Involve the entire circumference of the artery

Dissecting Aneurysm

Involve hemorrhage into the arterial wall


-general term designating primary desease of the myocardium
-enlarged heart
-often of obscure

Sinus Tachycardia

-an atrial

Sinus Bradycardia

-an atrial

Acyanotic Defects

-congenital heart defect
-ventricular septal defect
-patent ductus arteriosus

Ventricular Septal Defect

An abnormal opening in the wall between the right

Patent Ductus Arteriosus

A failure of that fetal structure to completely close at birth

Cyanotic Defect

1. Tetrology of Fallot
2. Transposition of the Great Vessel
3. Tricuspid Atresia
4. Truncus Arteriosus

Tetrology of Fallot

Four Defects:
1. Ventricular septal defect
2. Infundibular or Pulmonary valve stenosis
3. An aorta that overides the ventricular septal defect
4. Right ventricle hypertrophy

Severe Tetrology of Fallot

Infants may require a shunt between the aorta

Truncus Arteriosus

Characterized by having a single artery arising from both ventricles

Rigid Bronchoscopy

-typically used to remove foreign objects in children

Anteroposterior (AP)

These radiologic studies of the chest can determine the overall size of the heart

Cardiac Patient Preperation

-for posterolateral positioning
-OR personell should have 4' adhesive tape


-pleur-evac is a closed water-seal drainage system
-STSR should not allow the lens with light cord attached to touch drape as it may ignite the drape


Cannot be insufflated, double lumen endotracheal tubes allow single lung ventelation

Pump Oxygenerator

-"heart-lung machine"
-used in cardiac surgery to remove unoxygenated blood from the venous system, oxygenated

Cannula Placement

-into the right atrium for draining venous blood

Myocardial Protection

During cardiopulmonary bypass is accomplished with systemic hypothermia

Intra-Aortic Balloon Pump

-mechanical device designed for circulatory support AFTER cardiac procedures

Coronary Artery Bypass Grafting

There should never be water left on your back table because it is easily mistaken for saline when filling cannulae

Aortic Valve Replacement

-median sternotomy is performed
-bone wax is used to seal off bleeders from sternal walls

Repeat Cardiac Procedures

Be prepared to cannulate femorally

Permanant Pacemaker Insertion

1. Endocardial leads
2. Epicardial leads

Endocardial Leads

-pacemaker insertion
-generally placed through the subclavian vein into the right ventricle or atrium

Epicardial Leads

-pacemaker insertion
-attached directly to the myocardium during cardiac surgery or through a subxiphoid approach

Procedures for Correcting Tetrology of Fallot

-median sternotomy is performed
-cardiopulmonary bypass (CBP)


-false aneurysm
-pulsitile hematomas that are not contained by the vessel layers but are confined by a fibrous capsule

Thoracic Cavity

Has 3 divisions

Right Lung

Has 3 lobes

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