Definition Cardiac tumors include benign and malignant neoplasms arising within the cardiac chambers or in the myocardium. Metastatic neoplasms to the heart are not included. Historical Note First recognition of a heart tumor is attributed to Columbus in 1559, followed by Malpighi, who in 1666 wrote a dissertation entitled “De polypo cordis.” Morgagni wrote of heart tumors in 1762. By 1931, Yater was able to publish…

Definition Cardiac trauma is damage done to the heart by penetrating or nonpenetrating injuries. Section I Penetrating Cardiac Trauma Historical Note The first suggestion that wounds of the heart and great vessels could be sutured may have been by Roberts in 1881. In 1882 and 1895, studies of experimental closure of cardiac wounds in animals were reported. On September 9, 1896, Rehn in Germany successfully repaired…

Section I Bradycardia Definition Abnormal bradycardia is a slow cardiac rate that results chronically or episodically in inadequate cardiac output or life-threatening ventricular arrhythmias. Historical Note During the early 1700s, peripheral pulsations of the circulation began to be timed, and in 1717 Gerbezius recognized bradycardia as a deviation from the usual pulse rate. Morgagni is believed to have surmised the relationship between bradycardia and syncope in 1761,…

Definition This chapter discusses regurgitation and stenosis of the tricuspid valve in those uncommon situations in which it occurs as an isolated lesion, as well as tricuspid valve disease associated with mitral or combined mitral and aortic valve disease. Mitral valve surgery with coexisting tricuspid valve disease is also discussed in Chapter 11 . Tricuspid valve abnormalities or disease may be associated with various conditions discussed…

Definition Acquired diseases of both the aortic and mitral valves severe enough to require simultaneous surgery (replacement, repair, or valvotomy) are considered in this chapter. Because tricuspid valve disease may form part of this spectrum and require simultaneous surgery, it is also considered, although discussed in more detail in Chapter 14 . Historical Note Surgical treatment of combined aortic and mitral valve disease began during the…

Definition This chapter describes the surgical aspects of aortic valve disease, excluding congenital aortic stenosis in infants and children (see Chapter 47 ) and aortic regurgitation with either ventricular septal defect (see Chapter 35 ) or sinus of Valsalva aneurysm (see Chapter 36 ). Historical Note In 1947, Smithy and Parker at the University of South Carolina in Charleston first reported an experimental study of aortic…

Section I Mitral Valve Disease Definition This chapter describes surgical aspects of acquired mitral valve disease, excluding ischemic mitral regurgitation (see Chapter 10 ). Associated or secondary tricuspid valve disease is also considered (see Section II of this chapter and Chapter 14 ), as is concomitant coronary artery surgery in patients with nonischemic mitral valve disease (see Section III of this chapter). Historical Note Mitral Stenosis…

Definition Mitral regurgitation due to ischemic heart disease (ischemic mitral regurgitation) is mitral regurgitation caused by ischemic heart disease. This entity must not be confused with mitral regurgitation from other causes that coexist with ischemic heart disease. Historical Note Mitral regurgitation resulting from rupture of a papillary muscle has been long recognized as a rare and frequently catastrophic complication of acute myocardial infarction (MI). A case…

Definition Postinfarction ventricular septal defect (VSD) is an opening in the ventricular septum resulting from rupture of acutely infarcted myocardium. Historical Note In 1847, Latham first described a postinfarction VSD at autopsy, but it was not until 1923 that Brunn made the diagnosis clinically. In 1957, Cooley and colleagues first reported surgical repair of a postinfarction VSD 11 weeks after myocardial infarction (MI). The patient died…

Definition A postinfarction left ventricular (LV) aneurysm is a well-delineated transmural fibrous scar, virtually devoid of muscle, in which the characteristic fine trabecular pattern of the inner surface of the wall has been replaced by smooth fibrous tissue. In such areas, the wall is usually thin, and both inner and outer surfaces bulge outward. During systole, the involved wall segments are akinetic (without movement) or dyskinetic…

Definition Stenotic atherosclerotic coronary artery disease (CAD) is narrowing of the coronary arteries caused by thickening and loss of elasticity of their walls (arteriosclerosis) that, when sufficiently severe, limits blood flow to the myocardium. Initially, the disease limits only coronary flow reserve (increase in flow that normally accompanies increased myocardial oxygen demands), but when sufficiently advanced, CAD reduces blood flow through the affected artery even at…

Section I Generating Knowledge from Information, Data, and Analyses Introducing the Chapter What It Is About Cardiac surgical procedures, particularly coronary artery bypass grafting (CABG), are the most quantitatively studied therapies in the history of medicine. These studies reveal a complex, multifactorial, and multidimensional interplay among patient characteristics, variability of the heart disease, effect of the disease on the patient, conduct of the procedure, and response…

The primary determinants of a cardiac operation's success are events in the operating room (OR), but even patients who are seriously ill when they leave the OR can survive and have a good long-term result when postoperative care is appropriate and intensive. Conversely, ill-advised or overly energetic interventions early after operation can put a patient at risk who would otherwise convalesce normally. Normal convalescence is not…

Section I Anesthetic Consultation for Adult Cardiovascular Surgery The principal tasks of the anesthesiologist are to provide relief from pain for patients during operation and to provide optimal operative conditions for surgeons, both in the safest manner possible. To do this, the anesthesiologist must be a competent physician and a clinical pharmacologist, with a broad knowledge of surgery and the ability to utilize and interpret correctly…

To whatever extent possible, injury to the myocardium must be avoided during operations utilizing cardiopulmonary bypass (CPB). During these operations, alterations of myocardial blood flow and oxygen demand are often imposed that, unmodified, might injure cellular energetics and morphology. We have chosen to call the following general discussion one of management rather than protection of the myocardium. Most efforts at management will result in protection of…

Section I Hypothermic Circulatory Arrest Historical Note In 1950, Bigelow and colleagues, in their publications on experimental hypothermia produced by surface cooling, introduced the concept that whole-body hypothermia might be useful in cardiac surgery. They subsequently reported cooling dogs to 20°C by surface cooling, with recovery after 15 minutes of circulatory arrest. In 1951, Boerema and colleagues reported experimental studies indicating that when animals were cooled…

This chapter describes normal cardiac and great artery anatomy and dimensions, as well as the terminology usually employed. Cardiac Chambers and Major Vessels Accurate diagnosis of congenital heart defects depends in part on identifying cardiac chambers and major vessels by their morphology, regardless of their spatial positions ( Fig. 1-1 ). Right Atrium The right atrium ( Fig. 1-2 ) is the heart chamber that normally…