Cardiothoracic

• Diaphragm: T8 Vena Cava, T10 Esophagus (and vagi), T12 Thoracic duct and aorta (VET from 8-10-12)
• Type I alveoli: functional gas exchange; Type II: produce surfactant (decrease surface tension), 1% of alveoli
• Pre thoracotomy PFT's: need FEV1 > 2L / >1L >.6L for pneumonectomy/lobectomy/wedge. Need predicted post op FEV1 > 0.8
• Adenocarcinoma now # 1 lung CA; Squamous associated with PTH like substance; Small cell with ACTH, ADH
• T1: <3cm; T2>3cm; T3 invasion of chest wall, pericardium, diaphragm, <2cm from carina; T4 = unresectable = into mediastinum, heart, great vessel, esophagus, trachea, vertebra, effusion
• N1: ipsilateral hilar nodes; N2: ipsilateral mediastinal nodes; N3 = unresectable = contralateral or scalene or subclavian
• Stage I: T1-2, N0; II: T2, N1; IIIa up to T3 or N2, IIIb=unresectable T4 or N3; IV mets
• Pancoast tumor involves sympathetic chain (Horner's syndrome) and/or ulnar nerve
• 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 thymoma)
• Popcorn lesion on CXR classically is a hamartoma
• Thoracic outlet syndrome rarely involves artery or vein (1-3%), generally ulnar nerve paresthesias
• Spontaneous pneumothorax 10:1 male. 50% recur, then 75% of those again. Thoracoscopy for 2nd or continuous air leak
• Post MI Ventricular Septal Defect presents day 2-7; 2% of MI's; pan-systolic murmur
• SVC syndrome: 90% due to lung CA; Rx with RT
• Takayasu arteritis: young female, involves thoracic and abd aorta, and pumonary artery. Dx by angio
• Tissue valves (shorter lasting, but no anti-coag needed) used in pt who may become pregnant, has contraindication to coumadin; also used for all tricuspid replacements
• Rheumatic fever leads to mitral stenosis; see regurg with MI or valve degeneration
• Chylothorax (non iatrogenic) usually due to posterior mediastinal tumor (3/4) lymphoma. RT may help
• Thoracic duct injury: Rx with drainage/npo x 2 weeks; if not resolved then R thoracotomy, ligate duct
• Thoracic duct enters chest on RIGHT with aorta at T12, crosses to LEFT at T4, joins at IJ/Subclavian junction
• Thoracic aorta aneurysm: operate for >8cm, symptomatic
• Aortic Dissection: Type A - involves Ascending aorta, must operate. Type B does not involve the ascending aorta. Medical management (control HTN)
• CAD: leading killer in US (2 x 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 5 yr 80% patent; IMA graft 95% patency at 20 years
• VSD: #1 congenital cardiac defect, 50% close on their own, O.R. if symptomatic/failure to thrive
• PDA: 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 40msec before T wave, deflates with p wave

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