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.