General Surgery
Cardiothoracic Surgery
MBBS surgery notes on cardiothoracic surgery: coronary bypass, heart valves, lung cancer and pleural disease, mapped to NMC codes SU26.1 to SU26.3.
MedNext Academy | 3 min read
Cardiothoracic Surgery
MBBS surgery notes on cardiothoracic surgery: coronary bypass, heart valves, lung cancer and pleural disease, mapped to NMC codes SU26.1 to SU26.3.
This chapter introduces the surgical management of cardiac and thoracic disease. It covers coronary and valve surgery, the principles of cardiopulmonary bypass, lung cancer and the common pleural and mediastinal conditions the surgeon meets.
High-yield: Cardiothoracic Surgery
- Coronary artery bypass grafting is offered for significant left main or triple vessel coronary disease not suited to stenting.
- The left internal mammary artery graft to the left anterior descending artery has the best long-term patency.
- The great saphenous vein is a common conduit for coronary bypass but has poorer long-term patency than arterial grafts.
- Cardiopulmonary bypass takes over the work of the heart and lungs so the surgeon can operate on a still, bloodless heart.
- Mitral stenosis in India is most often rheumatic and can present with atrial fibrillation and haemoptysis.
- Aortic stenosis causes the triad of angina, syncope and breathlessness and, once symptomatic, carries a poor prognosis without valve replacement.
- Mechanical heart valves are durable but need lifelong anticoagulation, whereas tissue valves avoid anticoagulation but wear out sooner.
- A lung cancer is assessed for resectability by tumour stage and for operability by the patient lung and cardiac reserve.
- A solitary pulmonary nodule needs evaluation to distinguish benign causes such as granuloma from malignancy.
- An empyema is pus in the pleural space and is treated by drainage and antibiotics, with decortication if it becomes organised.
- A pleural effusion is investigated by aspiration, and Light criteria separate an exudate from a transudate.
- Bronchiectasis is permanent dilatation of bronchi with chronic productive cough and recurrent infection.
- A mediastinal mass is worked up by its compartment, as anterior masses suggest thymoma, teratoma, thyroid and lymphoma.
- Myasthenia gravis is associated with thymoma, and thymectomy can improve the disease.
- Postoperative chest drains after thoracic surgery are managed on an underwater seal to re-expand the lung and drain air and fluid.
Heart valve prostheses
- **Mechanical valve:** Very durable but requires lifelong anticoagulation; preferred in younger patients.
- **Tissue valve:** Avoids long-term anticoagulation but degenerates over time; preferred in older patients.
- **Best coronary graft:** Left internal mammary artery to the left anterior descending has the best long-term patency.
- **Cardiopulmonary bypass:** Oxygenates and circulates blood so the heart can be stopped for surgery.
NMC competencies in this chapter
- **SU26.1:** Cardiac surgery: coronary and valve disease and bypass
- **SU26.2:** Thoracic surgery: lung cancer and pleural disease
- **SU26.3:** Mediastinal disease and thoracic surgical principles
Frequently Asked Questions
Which is the best conduit for coronary bypass?
The left internal mammary artery grafted to the left anterior descending artery has the best long-term patency and survival benefit, so it is the preferred conduit where possible.
How do mechanical and tissue heart valves differ?
Mechanical valves are very durable but need lifelong anticoagulation, while tissue valves avoid anticoagulation but degenerate over time, so the choice depends on patient age and preference.
What is the classic triad of aortic stenosis?
Angina, syncope and breathlessness. Once symptoms appear the prognosis without valve replacement is poor, so symptomatic severe stenosis is an indication for surgery.
What is an empyema and how is it treated?
Pus in the pleural space, usually secondary to pneumonia. It is treated by drainage and antibiotics, with surgical decortication if the empyema becomes thick and organised.
Continue reading
MBBSAll General Surgery chapters
Continue through the General Surgery chapter map.
Continue studying General Surgery
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans