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Ch11: Cardiothoracic Surgery - Coggle Diagram
Ch11: Cardiothoracic Surgery
CABG
indicated when >70% stenosis
can be done with valvular surgery
conduits: LIMA, radial art, GSV, internal thoracic art
triple bypass: LIMA to LAD, GSV for circumflex to aorta, GSV for RCA to aorta
Valvular heart disease
bioprosthetic valves have a shorter lifespan (10-15yrs)
AS
ej sys murmur
surgery when sx or mean gradient across valve>40mmHg
surgical options: open replacement vs TAVI (transcatheter aortic valve implatation)
MR
pansys murmur, radiates to axilla
can be comp of ischaemia, rheumatic disease, IE, CTDs
open valve replacement vs endovasc mitraclip
MS
rumbling mid dias murmur @ apex
tapping apex
most commonly caused by rheumatic heart disease
tx: percut valvotomy vs open replacement
AR
acute = emergency, caused by IE + aortic dissection
wide pulse pressure (Corrigans water hammer pulse)
Pneumothorax
primary spontaneous
rupture of subpleural blebs usually @ apex
if <2cm can do conservative tx (o2 + monitoring)
secondary spontaneous
lung disease
malignancy
CTD
traumatic
exam findings: hyperresonant hemothorax + absent breath sounds on that side
Tx
needle aspiration if >2cm
chest drain
4th/5th ICS ant to mid axillary line just above rib to avoid NV bundle
Safe triangle: pec major, lat dorsi, 5th ICS
look for air bubbling, oscillation of fluid with resp, confirm with CXR
bullectomy
pleurodesis
methods: talc or pleural stripping
post op pyrexia = sign of success
avoid if patient may need lung transplant in future