TSRA Review of Cardiothoracic Surgery Carlos M. Mery Joseph W. Turek TSRA Review of Cardiothoracic Surgery Edited by: Carlos M. Mery, MD, MPH Cardiothoracic surgery fellow University of Virginia Charlottesville, VA President TSRA 2010 – 2011 Joseph W. Turek, MD, PhD Congenital cardiac surgery fellow Children’s Hospital of Philadelphia Philadelphia, PA President TSRA 2009 – 2010 Thoracic Surgery Residents Association www.tsranet.org TSRA Review of Cardiothoracic Surgery Copyright © 2011 by the Thoracic Surgery Residents Association, Carlos M. Mery, Joseph W. Turek TSRA / TSDA 633 N. Saint Clair Street Suite 2320 Chicago, IL 60611 www.tsranet.org Disclaimer The material presented herein is, to the best of our knowledge, accurate and factual to date. The information is provided as a basic guideline for the study of cardiothoracic surgery and should be used in conjunction with a variety of other educational references and resources. The TSRA Re- view of Cardiothoracic Surgery should not be construed as a definitive study guide for either the TSDA In-Training Exam or the ABTS Certification Exam. TSRA makes no claims regarding the study guide's value in preparing for, or its contribution toward performance on, either the TSDA In-Training Exam or the ABTS Certification Exam. All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying or the use of any information storage and retrieval system without written permission from the copyright owners. Cover artwork by: Carmina Mery, Ramón Mery, and Mari Pili Guzmán (age 3) To all cardiothoracic surgery residents, present and future. !"#$%"#&' The Thoracic Surgery Directors Association (TSDA) is dedicated to the education of all cardio- thoracic surgery residents and has spent considerable time and resources to create a comprehen- sive curriculum to help residents develop their surgical knowledge bases. Cardiothoracic surgery residents represent the future of our specialty and this unique book, developed by residents for residents, is a shining example of why we are so proud to be cardiothoracic surgeons. The 83- chapter compendium, developed and written by members of the Thoracic Surgery Residents As- sociation (TRSA), provides superb individual summaries of important cardiothoracic surgery topics and should be an invaluable asset to cardiothoracic surgeons in every stage of training. The review book's contributors, including editors Carlos Mery, MD and Joseph Turek, MD, should be congratulated for their vision, contribution to educational resources for residents, and combined resolve to improve resident education. As President of the TSDA, I thank each of them for this considerable effort and I challenge every cardiothoracic resident to incorporate this body of knowledge into their daily activities for the benefit of our patients. George L. Hicks, Jr., MD President Thoracic Surgery Directors Association July 2011 (#$)*+$' As the field of cardiothoracic surgery continues to evolve, the amount of knowledge that a cardi- othoracic surgeon must acquire continues to increase. There are several excellent and estab- lished textbooks in cardiothoracic surgery; however, there are few review books that can serve as a concise analysis of the field. The goal of this book, edited by the Thoracic Surgery Residents Association (TSRA) and au- thored by more than 50 cardiothoracic surgery residents from different programs around the country, is to synthesize the breadth of information that a cardiothoracic surgeon has to be famil- iar with into a few hundred pages. This brief review book is not intended to be exhaustive, but rather to relay essential information in cardiothoracic surgery to residents and established sur- geons alike. The material is organized into four different sections: General Thoracic Surgery, Adult Cardiac Surgery, Congenital Cardiac Surgery, and Cardiothoracic Trauma and Critical Care. The materi- al included in each of the chapters is well known to anyone familiar with the topic and can be found in most cardiothoracic surgery textbooks. The books and journal articles that served as source material are listed at the end of the book. We would like to thank the Thoracic Surgery Directors Association (TSDA) for their support with this project and all other initiatives. We would particularly like to thank the TSRA commit- tee members and the multiple contributors that made the creation of this book possible. Carlos M. Mery Joseph W. Turek July 2011 ,"-.#/01."#2' Ibrahim Abdullah, MD Children's Hospital Boston Palliative operations, Total anomalous pulmonary venous return, Truncus arteriosus and aortopulmonary window Carlos J. Anciano, MD University of Pittsburgh Esophageal cancer Nicholas D. Andersen, MD Duke University Medical Center Cardiac tumors, Hypoplastic left heart syndrome Ashok Babu, MD University of Colorado Cardiac anatomy, Cardiopulmonary bypass, Postoperative care and perioperative neurological complications Keki R. Balsara, MD Duke University Medical Center Double outlet right ventricle Bryan M. Burt, MD Brigham and Women's Hospital Pulmonary metastatic disease, Malignant pleural effusions and malignant pleural mesothelioma, Aortic valve disease, Cardiac trauma, Ventricular septal defects Shamus R. Carr, MD University of Pittsburgh Paraesophageal hernias George M. Comas, MD Columbia University Medical Center Cardiac transplantation Mani A. Daneshmand, MD Duke University Medical Center Thoracoabdominal aortic aneurysms Elizabeth A. David, MD The University of Texas M.D. Anderson Cancer Center Surgery for emphysema Daniel J. DiBardino, MD University of Michigan Cardiac embryology and segmental approach, Pediatric cardiac intensive care !"#$%&'($"%)* +&&* Lucas M. Duvall, MD University of Texas Health Sciences Center at San Antonio Tricuspid valve repair and replacement, Thoracic trauma Leo M. Gazoni, MD University of Virginia Mechanical complications of coronary artery disease, Left ventricular aneurysms Ravi K. Ghanta, MD Brigham and Women's Hospital Pulmonary metastatic disease, Malignant pleural effusions and malignant pleural mesothelioma, Aortic valve disease, Cardiac trauma, Ventricular septal defects Shawn S. Groth, MD, MS University of Minnesota Early stage non-small cell lung cancer, Tracheal tumors Kendra J. Grubb, MD, MHA University of Virginia Mediastinal masses, Coronary artery disease John C. Haney, MD, MPH Duke University Medical Center Thoracic and pulmonary anatomy Matthew G. Hartwig, MD Duke University Medical Center Locally advanced lung cancer, Thoracic infections and hemoptysis James M. Isbell, MD, MSCI University of Virginia Lung transplantation, Anatomy and surgical approaches to the mediastinum J. Chad Johnson, MD, MS Duke University Medical Center Aortic dissection Zain Khalpey, MD, PhD, MRCS Brigham and Women's Hospital Endocarditis, Low cardiac output Ahmet Kilic, MD University of Virginia Combined valve / coronary artery bypass grafting, Tricuspid atresia T. K. Susheel Kumar, MD University of Michigan Cardiac embryology and segmental approach +&&&* ,-./*.0+&01*"2*!3%4&"$5"%36&6*-(%70%8* John C. Lin, MD Cedars-Sinai Medical Center Congenital cardiac evaluation and physiology, Interrupted aortic arch and aortic coarctation, Transposition of the great arteries Gabriel Loor, MD Cleveland Clinic Foundation Diseases of the pericardium Robroy H. MacIver, MD, MPH University of Washington Paraneoplastic syndromes, Benign pleural disease, Patent ductus arteriosus Ryan A. Macke, MD University of Pittsburgh Anatomy and physiology of the esophagus Jenifer Marks, MD The University of Texas M.D. Anderson Cancer Center Pulmonary physiology and pulmonary function tests, Pulmonary carcinoid tumors and other primary lung tumors Jeremiah T. Martin, MD University of Kentucky Chest wall deformities, Congenital diseases of the esophagus, Esophageal diverticula Stephen H. McKellar, MD, MSc Mayo Clinic Combined carotid and coronary artery surgery, Ascending aortic aneurysms, End-stage heart failure Robert A. Meguid, MD, MPH University of Washington Chest wall tumors Serguei I. Melnitchouk, MD, MPH Columbia University Medical Center Acute and chronic pulmonary embolism Carlos M. Mery, MD, MPH University of Virginia Other esophageal tumors, Atrial septal defects, Tetralogy of Fallot, Ebstein's anomaly Bret A. Mettler, MD Children's Hospital Boston Palliative operations, Total anomalous pulmonary venous return, Truncus arteriosus and aortopulmonary window Stephanie Mick, MD Brigham and Women's Hospital Benign tumors of the lung, Atrioventricular septal defects, Vascular rings, pulmonary artery sling, and associated tracheal anomalies !"#$%&'($"%)* &9* Daniela Molena, MD Memorial Sloan-Kettering Cancer Center Lung cancer overview and preoperative evaluation, Diseases of the diaphragm, Esophageal motility disorders Jennifer S. Nelson, MD University of Michigan Aortic stenosis and left ventricular outflow tract obstruction Tom C. Nguyen, MD Columbia University Medical Center Mitral regurgitation, Mitral stenosis Aundrea L. Oliver, MD Brigham and Women's Hospital Esophageal reflux disease Theolyn Price, MD Mayo Clinic Post-pneumonectomy complications, Congenital lung diseases, Interstitial lung disease Siva Raja, MD, PhD Cleveland Clinic Foundation Esophageal reflux disease Keshava Rajagopal, MD, PhD Duke University Medical Center Pacemakers and defibrillators Ramesh Singh, MBBCh, MRCS University of Colorado Cardiac anatomy, Cardiopulmonary bypass, Postoperative