Cardiothoracic Surgery

 

Thoracic

Lung Abscess

  • Dx: Patients present with fever, chest pain. Diagnose with CT chest.
  • Tx: Managemnt with antibiotica, IR drainage, or surgical drainage.
    • Indications for drainage:
      • >6cm
      • not responding to 8wk antibiotics
      • immunocompromised or critically ill
      • empyema
    • Indications fo surgery:
      • hemoptysis
      • can't exclude cancer
      • bronchopleural fistula
    • Operative treatment involves thoracotomy, cut down on percutaneous catheter, and placement of chest tube. Lobectomy may be required for complicatoins.

Lung Cancer

  • Dx: Patients present as smokers with weight loss, cough, hemoptysis.
  • Tx: Management is surgical resection and/or cisplatin, etoposide, XRT.
    • Contraindications to resection include:
      • T3, T4, N3
      • <2cm from carina
      • invading structures
      • contralateral nodes or scalene nodes

Mediastinal Mass

  • Dx: Mass is usually found on CT scan
    • Tumor markers include AFP, bHCG, TSH/T4, Urine catecholamines
    • Anterior mediastinum= thyroid, parathyroid, thymus, thymoma, teratoma.
    • Middle mediastinum= bronchogenic cyst, pericardial cyst, lymphoma, sarcoma, granuloma.
    • Posterior mediastinum= esophageal duplication cyst, lymphoma.

 Pleural Effusion

  • Dx: Fluid analysis can differentiate causes (transudate versus exudate).
    • Glucose < 3.3 and pH < 7.3 is complicated effusion / empyema, malignancy, TB, esophageal rupture, RA, or SLE (exudate).

Pneumonectomy

  • % Predicted postoperative FEV1 =% Preoperative FEV1 - (preoperative FEV1 × no. segments to be removed/18)
  • want > 35% postoperative FEV1 for age, ht, sex.
  • When the FEV1 is greater than 2 L or 50% of predicted, major complications are rare.

Special Cardiac Topics

  • Recent MI
    • Ideally wait 6mo after for surgery
    • Bare metal stent can have surgery after 4 weeks with asa/plavix held
    • Coated stent needs 1yr of asa/plavix
    • Use perioperative Beta blockers.