Download Operative Cardiac Surgery, Fifth edition by Timothy J. Gardner, Thomas L. Spray, Timothy Gardner PDF

By Timothy J. Gardner, Thomas L. Spray, Timothy Gardner

Earlier variants of this e-book (formerly released within the Rob & Smith sequence) have proven it because the pre-eminent advisor to operative surgical procedure of the guts and nice vessels. This new version acknowledges the expanding subspecialization in surgical procedure via positioning the e-book for the professional cardiac health care professional. The paintings is an immense revision edited via well-respected American surgeons and incorporates a host of prestigious foreign contributors.

The scope of the ebook is absolutely up to date with smooth perform, together with descriptions of minimally invasive and 'off-pump' procedures.

Each strategy is illustrated by means of a sequence of step by step complete color line illustrations of remarkable caliber - constantly stated in industry learn because the top approach to demonstrating surgical strategy - with precise notes on operative strategy. extra textual content describes the foundations and justification of selecting every one technique, preoperative evaluation and practise together with anaesthetic facets, postoperative care and outcomes.

The ebook is a optimal instructing reduction on operative cardiac surgical procedure for citizens and trainees and a useful reference for skilled cardiothoracic surgeons coming near near strange or unusual tactics.

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Example text

G. bicuspid AV, rheumatic disease, senile calcification). 15 Myxomatous valvular disease produces redundant, and often prolapsing, cusps. This ME AV LAX view demonstrates a prolapsing AV with vegetations (arrow). 15 16 ME AV LAX view demonstrating severe aortic regurgitation (arrow). Endocarditis of the AV produces aortic regurgitation either due to cusp or annular destruction. Vegetations and abscesses are common. 16 26 Echocardiography for cardiac surgery 17 ME AV LAX view. Dilatation of the aortic root with normal cusp morphology can lead to aortic regurgitation owing to the lack of normal supporting structures.

The ACT is monitored every 20–30 minutes during bypass to ensure that adequate anticoagulation is maintained. Required flow rates for cardiopulmonary bypass depend on the patient’s body surface area and temperature. 2 L/m2 per minute is required for adequate perfusion. Oxygen consumption is reduced, however, by 50 per cent for every 10°C drop in temperature. At 20°C, a 30-minute period of circulatory arrest can be safely tolerated. A guide to the adequacy of tissue perfusion can be achieved by measurement of the mixed venous oxygen saturation.

Accordingly, additional intravenous agents are typically administered at these times. 40 Cardiopulmonary bypass: access and technical options OPERATION Incision and access 2a In the majority of operations that require cardiopulmonary bypass, access is via the median sternotomy. The actual skin incision may begin inferior to the suprasternal notch to reduce the length of the external scar after surgery. Median sternotomy incision 2a Left innominate vein Sternal retractor SVC Pericardial edge Aorta Pulmonary trunk IVC 2b Right ventricle 2b After sternal division, a sternal retractor is placed with the ratchet positioned at the upper end of the wound.

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