Published on 10/04/2015 by admin

Filed under Surgery

Last modified 10/04/2015

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CHAPTER 9 Thorax

Heart and great vessels

Principles of cardiac surgery


Most open-heart surgery is carried out via a median sternotomy incision. Closed mitral valvotomy used to be carried out via a left thoracotomy – the operation is rarely performed nowadays. A left posterolateral thoracotomy is used for ligation of a patent ductus arteriosus.

Postoperative complications

Congenital heart disease

The following lesions are most commonly encountered (in order of decreasing frequency): VSD, ASD, PDA, pulmonary stenosis, aortic stenosis, tetralogy of Fallot, coarctation of the aorta and transposition of the great vessels. Congenital heart disease may be classified as cyanotic (significant R-to-L shunt) or acyanotic (L-to-R or no shunt). The reader is referred to a textbook of medicine for the symptoms, signs and investigations of these conditions. The treatment and prognosis are indicated below.


Acquired valvular heart disease

Ischaemic heart disease