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SurgSpace / Specialties / Cardiac Surgery

Cardiac Surgery

The heart and great vessels: bypass grafting built on the coronary map, valve repair and replacement stitched millimetres from the conduction system, and the physiology of cardiopulmonary bypass, the machine that lends the patient a heart and lungs for an hour.

3 operations in depth5 interactive cases

Backdrop: A cardiac surgery operating room · Pfree2014 · CC BY-SA 4.0

See the disease

Conditions

The diseases, each with the image that defines it.

Each disease with the image that defines it: what it looks like, what the scan shows, and which operation answers it.

Coronary artery disease

The commonest reason a cardiac surgeon operates.

Pathophysiology
Atherosclerotic plaque narrows the epicardial coronaries; demand outstrips supply, first on exertion, then at rest, then as infarction.
Presentation
Stable angina, acute coronary syndromes, ischaemic cardiomyopathy, or an incidental finding on the way to another operation.
Investigations
The angiogram is the surgical map: which vessels, how proximal, how diffuse. Echo answers what the ischaemia has already cost the ventricle.
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Medical therapy, PCI, or CABG
Everyone gets medical therapy. PCI treats discrete lesions; CABG bypasses whole territories, and earns its keep in left main, proximal LAD, multivessel and diabetic disease.
Operative risk
Age, ventricular function, kidneys, lungs, frailty and the aorta itself: risk scores frame the conversation, the heart team makes it.
After surgery
ICU overnight, drains and pacing wires out over days, and the graft's future decided by secondary prevention as much as by the anastomosis.
Coronary artery bypass graftingCase: The widow-maker lesion
Angiography
Coronary angiogram of the left coronary system, the arteries drawn in dark contrast against a grey field, with a tight narrowing in the proximal left anterior descending artery
Coronary angiography · a preocclusive stenosis in the proximal LAD after thrombus aspiration

Aortic stenosis

A pressure-loaded ventricle running out of road.

The valve
Calcific degeneration of a tricuspid or bicuspid valve narrows the outflow; the ventricle hypertrophies to compensate until it cannot.
Presentation
Angina, syncope, failure: the classical triad, in roughly worsening prognostic order. Severe symptomatic AS untreated has a survival measured in a few years.
Echo
Mean gradient, valve area and jet velocity grade severity; ventricular function and wall thickness show the cost so far.
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SAVR and TAVR
Surgical replacement and transcatheter implantation now share this disease; age, anatomy, access and operative risk pick the route, together, in the heart team.
Aortic valve replacementCase: Syncope on the stairs
Ultrasound
Continuous-wave Doppler trace through the aortic valve from a transthoracic echocardiogram, with the measured peak velocity and gradients listed beside a small two-dimensional image
Echocardiography · continuous-wave Doppler through a stenotic aortic valve, from a CardioNetworks ECHOpedia case

Aortic dissection

A tear in the wall of the body's largest artery, on a timer.

Classification
Stanford type A involves the ascending aorta and is an immediate surgical emergency; type B begins beyond the left subclavian and is usually managed medically first.
Presentation
Tearing pain to the back, pulse deficits, new aortic regurgitation, tamponade, or a stroke: the dissection presents as whatever branch it has stolen.
Imaging
CT angiography is the map: entry tear, extent, branch involvement, and the pericardium. Bedside echo finds the effusion when the patient cannot travel.
Learn more
Type A surgery
Replace the ascending aorta before it ruptures into the pericardium: an emergency operation under deep organisation, whose details live with the operative pages as they are built.
Case: Tearing pain to the back
Educational illustration
Schematic drawing of the aorta from the arch to the iliac bifurcation with the dissection shaded along the ascending and descending segments, labelled DeBakey I and Stanford A
Aortic dissection, illustrated · a DeBakey type I (Stanford A) dissection involving ascending and descending aorta

  • Mitral regurgitation

    Repair the valve before the ventricle pays for it.

    Mechanism
    Primary MR is a diseased valve (prolapse, flail, endocarditis); secondary MR is a normal valve stretched by a failing, dilating ventricle.
    Echo
    Severity, mechanism and reparability all come from the echo, which is why the mitral decision is made in the echo lab before it is made in theatre.
    Repair versus replacement
    Repair preserves the valve and the ventricle's geometry and is preferred whenever durable; replacement answers destruction repair cannot fix.
    Mitral valve repair

  • Infective endocarditis

    An infection surgery joins when the valve starts failing.

    When surgery enters
    Heart failure from valve destruction, uncontrolled infection or abscess, and recurrent emboli despite antibiotics: the three doors into theatre.
    The operative problem
    Debride everything infected, then restore a competent valve: repair where tissue allows, replacement where it does not.
    The team
    Endocarditis is run by a team: microbiology chooses and times the antibiotics, imaging tracks the valve, and surgery decides when waiting has become the risk.
    Aortic valve replacementMitral valve repairCase: Fever, and a murmur that is new

Hub shaped by the Surgical Specialties Lead with the Cardiac surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.