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Patients who are undergoing thoracic surgery require careful attention in the perioperative period. These patients are often older and have baseline abnormalities of lung function, decreased nutritional status, and other comorbid diseases. Postoperatively, factors that influence patient recovery include removal…
The decision to proceed with any surgical procedure involves a careful consideration of the anticipated benefits of surgery and an assessment of the risks associated with the surgical procedure. An important component of estimating the benefit of surgery is knowledge…
Since the late 1990s advances in imaging technology, including digital subtraction chest radiographs, multidetector spiral computed tomography (MDCT), dual-energy computed tomography (CT) techniques, electrocardiograph (ECG)-gated CT, positron emission tomography (PET) with CT, and magnetic resonance imaging (MRI), have improved diagnostic…
The thorax is the upper part of the trunk, bounded by the diaphragm inferiorly, the thoracic inlet superiorly, and the thoracic cage between. Vital organs, such as the heart and lungs, reside completely within the thoracic cavity, and other, equally…
Step 1 Preoperative Considerations ◆ Chronic thromboembolic pulmonary hypertension (CTEPH) is an increasingly recognized clinical entity. Pulmonary embolism (PE) is a common disease, with an annual incidence of about 100/100,000 in the United States. Many episodes of PE, however, are…
Donor Step 1 Surgical Anatomy and Exposure ◆ The potential donor is placed supine on the operating room table. The standard incision for the multiorgan donor is a midline sternotomy incision extended into a midline abdominal incision to expose the…
See Video 32.1 on ExpertConsult.com . ◆ Since the first implantation of a left ventricular assist device (LVAD) by Dr. Michael DeBakey in 1966, the search for durable short- and long-term mechanical support has resulted in a myriad of devices…
◆ Extracorporeal membrane oxygenation (ECMO) pertains to prolonged extracorporeal cardiopulmonary bypass using intrathoracic or extrathoracic vascular cannulation. The bypass circuit includes a distensible venous blood reservoir receiving deoxygenated blood from the patient passing through a nonocclusive centrifugal pump toward the…
◆ Amelioration of left ventricular (LV) remodeling is an appealing target for medical and surgical therapies for heart failure. Remodeling is a complex process that leads to maladaptive ventricular dilation, hypertrophy, and altered ventricular wall stress and may occur after…
Step 1 Surgical Anatomy ◆ Knowledge of the anatomy involved with hypertrophic cardiomyopathy (HCM) is paramount in understanding the pathophysiology that ultimately contributes to dynamic subaortic obstruction. ◆ HCM is defined as left ventricular (LV) hypertrophy in the absence of…