CHAPTER 9 Thorax
Heart and great vessels
Principles of cardiac surgery
Contraindications for surgery
Correction of a defect alone may be contraindicated in the presence of the following:
Preoperative preparation
• Accurate diagnosis. This requires not only a full examination but a variety of investigations, including CXR, ECG, echocardiography, Doppler’s, cardiac catheterization, MRI, cardiac CT, radionuclide scanning, pulmonary function tests
Postoperative complications
Renal failure
Due to ATN, resulting from renal hypoperfusion. Haemofiltration/haemodialysis may be required.
Congenital heart disease
Acyanotic
Acquired valvular heart disease
Ischaemic heart disease
Aetiology
Male sex, smoking, family history, hypertension, hyperlipidaemia, diabetes, obesity, myxoedema.
Investigations
• ECG: may be normal at rest in up to 75% of patients; S-T depression with angina – exercise ECG usually confirms diagnosis
• Cardiac catheterization and coronary angiography – contrast medium is injected into each coronary artery and views recorded by cinephotography; the site and severity of disease is assessed