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Diaphragm:

  • T8 =Vena Cava

  • T10 =Esophagus (and vagi)

  • T12 =Thoracic duct and aorta

Type I pneumocyte: functional gas exchange

Type II pneumocyte:

  • Produce surfactant (decrease surface tension)

  • 1% of alveoli

Pre-thoracotomy PFTs: need for:

  • Pneumonectomy: FEV1 > 2L

  • Lobectomy: FEV1 > 1L

  • Wedge resection: FEV1 > 0.6L

  • Need predicted postop FEV1 > 0.8

Adenocarcinoma: now #1 lung CA

Squamous: a/w PTH-like substance;

Small cell: a/w ACTH, ADH

Tumor Grading:

  • T1: < 3cm

  • T2: > 3cm

  • T3: invasion of chest wall, pericardium, diaphragm, < 2 cm from carina

  • T4: unresectatble = into mediastinum, heart, great vessel, esophagus, trachea, vertebrae, effusion.

  • N1: ipsi hilar nodes

  • N2: ipsi mediastinal

  • N3: unresectable = contralateral or scalene or subclavian nodes

Stages:

  • Stage I: T1-2 N0

  • Stage II: T2N1;

  • Stage IIIa: up to T3 or N2

  • Stage IIIb: unresectable T4 or N3

  • Stage IV: Mets M1

Pancoast tumor:

  • Involves sympathetic chain and/or ulnar nerve

  • (Horner's syndrome)

Left lung can drain: to right mediastinum (left to right, like reading)

Thymoma: indication for resection

Resecting thymus: (even if no thymoma) in myasthenia gravis improves 90% (10% of m.g. have thymomas)

Popcorn lesion: on CXR is classically a hamartoma

Thoracic outlet syndrome:

  • Rarely involves artery or vein (1-3%)

  • Generally ulnar nerve paresthesias.

Spontaneous PTX: 10:1 male predilection

  • 50% recur then 75% of those again

  • Thoracoscopy for 2nd or continued air leak

Post MI Ventricular Septal Defect:

  • Presents day 2-7

  • 2% of MI's

  • Pan-systolic murmur

Superior Vena Cava syndrome:

  • 90% due to lung CA

  • Tx with XRT

Takayasu arteritis:

  • Young female

  • Involves:

  • Thoracic aorta

  • Abdominal aorta

  • Pulmonary Artery

  • Dx by angiography

Tissue valves:

  • (Shorter lasting, but no anti coagulation needed)
  • Use in patient who may become pregnant\
  • Has contraindication to Coumadin
  • Also used for all tricuspid replacements

Rheumatic fever:

  • Leads to mitral stenosis
  • See regurgitation with MI or valve degeneration

(Non-iatrogenic) Chylothorax:

  • Usually due to posterior mediastinal tumor
  • (75% lymphoma)
  • XRT may help.

Thoracic duct:

  • Enters chest on Right with Aorta at T12
  • Crosses to Left at T4
  • Joins IJ/Subclavian junction.

Thoracic duct injury:

  • Tx with drainage/NPO x 2 weeks
  • If not resolved then R thoracotomy è ligate duct

Thoracic aorta aneurysm:

  • Operate for >6 cm, symptomatic
  • 60-70% of > 6 cm die in 2 years of Diagnosis

Aortic Dissection:

Stanford:

  • Type A: Involves ascending aorta è must operate

  • Type B: Does not involve ascending aorta

  • Medical management of HTN

DeBakey:

  • Type I: Ascending and descending

  • Type II: Ascending only

  • Type III: Descending only

CAD: Leading killer in U.S. (2x Cancer)


CABG indications:

  • Intractable symptoms

  • > 50% left main

  • Triple vessel disease, or 70% LAD + 1 other vessel

Angioplasty:

  • 20% restenosis by 1 year

  • Vein graft: 5yrs è 80% patent, @10yrs =50%-60%.

  • IMA graft patency: 95% at 20 years

Ventricular Septal Defect:

  • #1 cardiac congenital defect

  • 50% close on their own

  • OR if symptomatic or failure to thrive

'PDA ('patent ductus arteriosus):

  • Close all those that indomethacin does not at 6 months of age


IABP:

  • Augments diastolic coronary blood flow and reduces afterload by inflating during diastole

  • Inflates 40 msec before T wave

  • Deflates with p wave.

Aortic valve (N=2.5-3.5 cm²)

  • Symptoms < 1cm² & critical < 0.7cm²

Mitral valve (N=4-6 cm²)

  • Symptoms - 1.5-2 cm² & severe < 1.0 cm²

Pages in category "Cardiothoracic"

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