midline sternotomy
- valve surgery
- CABG
- cardiac transplant
- congenital cardiac defects
signs of CABG
vein harvesting on legs
mini-sternotomy
- for aortic valve replacement
- from the substernal notch to the 3rd or 4th intercostal space
- a J-shape towards the right.
posterolateral thoractomy
- mid-spinal line to the anterior axillary line.
anterolateral thoracotomy
- mid-axillary line to the lateral sternal border.
indications for thoractomy
- lobectomy - malignancy / recurrent infection / trauama / infarction
- pneumonectomy
- open lung biopsy
- lung vol reduction
- bullectomy
- pleurectomy - recurrent pneumothoraces or effusions
- single lung transplant
- minimally invasive cardiac surgery
- oesophagectomy (look for laparotomy scars)
signs of lobectomy and pneumonectomy
dull percussion
reduced/absent breath sounds
clamshell incision
- widespread traumatic chest injury
- bilateral transplant - look for signs of immunocompromise
- malignancy
signs of immunocompromise
- bruising or a cushingoid appearance from steroid use
- tremor or gum hypertrophy from cyclosporin use
- signs of infection
- signs of rejection or transplant failure.
indications for lung transplant
CF
bronchiectasis
COPD
pul fibrosis
subclavicular incision
- pacemaker insertion - usually palpable
indications for pacemaker
AF
sick sinus syndrome
AV block
heart failure
defibrillator function
types of pacemaker
- single chamber - wire to RA or RV
- dual chamber - 2 wires to RA and RV
- triple chamber RA RV and LV
what are triple chamber pacemakers used for
cardiac resynchronisation therapy - in certain HF pts
borders of the safe triangle
- anterior border of latissimus dorsi,
- the lateral border of pectoralis major,
- the base of the axilla
- the 5th intercostal space.
what is VATS surgery
keyhole surgery
2 or 3 small incision in ports
enter thoracoscope and surgical instruments tp manipulate issues
indications for VATS surgery
biospy and / or removal of suspicious masses
pleurodesis - recurrent pleural effusion / pneumothorax
biospy of mediastinal nodes
benefits of VATS surgery
- reduce need for muscle division
- reduce risk iatrogenic rib fracture
- improved recovery time
