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Cardiothoracic Surgery
Chapter 22
Anatomy of the Chest

Thorax (Chest)

3 Divisions separated by pleura.
Right pleural cavity containing the
right lung. (Has 3 lobes)
 Left pleural cavity containing the left
lung. (2 lobes)
 Mediastinum containing the
esophagus, trachea, thymus and
heart.

Anatomy of the Chest

Thorax (Chest)
Lined with thin membrane called
parietal pleura.
 Lungs are covered with separate
membrane called the visceral
pleura.
 Space between these membranes
is known as the pleural space.


Contains serous lubricating fluid to
reduce friction during respiration.
Anatomy of the Chest

Trachea
Cylindrical pipe connecting the
larynx to the lungs.
 Passageway for air.
 Embedded with c-shaped rings of
hyaline cartilage.


Prevents trachea from collapsing
during breathing.
Anatomy of the Chest

Bronchial tree

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Division of the trachea into two
passageways for air to each lung.
Primary bronchi divide into smaller
passageways called secondary lobar
branches, one for each lobe.
Further division:

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Segmental bronchi
Bronchioles
Alveolar ducts
Alveoli
Anatomy of the Chest

Lungs
Large spongy organs located from
the diaphragm to just above the
clavicle.
 Designed for exchange of oxygen
and CO2.

Cardiothoracic Surgery
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Trachea, Lungs and related Structures
Cardiothoracic Surgery
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Lung structure: (a) Lobes and fissures (b)
Alveoli and exchange of gases
Anatomy of the Heart

Heart

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Hallow, muscular organ located in the
mediastinum slightly left of midline.
Enclosed in a loose sac called
pericardium.

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
Fibrous
Serous
Area between known as pericardial
cavity with serous fluid to reduce friction.
Cardiothoracic Surgery
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Percardium
Anatomy of the Heart

Heart wall

Composed of three layers:
Epicardium (outer layer)
 Myocardium (Middle, muscle layer)
 Endocardium (inner layer)

Anatomy of the Heart

Heart chambers

2 upper atriums
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2 lower ventricles
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Receiving chambers
Pumping chambers
Divided by valves and septum.
Anatomy of the Heart

Heart valves
Right atrium and right ventricle are
separated by the tricuspid valve.
 Left atrium and left ventricle are
separated by the mitral or bicuspid
valve.
 Fibrous cords prevent the valves
from folding back.


Chordae tendineae
Cardiothoracic Surgery

Structures within the Thorax
Anatomy of the Heart

Blood flow
1.
Right atrium receives unoxygenated
blood from the body.

2.
3.
4.
5.
6.
Vena cava
Tricuspid valve
Right ventricle
Pulmonary lunar valve
Pulmonary artery
Capillaries of the lungs
Anatomy of the Heart
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Blood flow
7.
Pulmonary vein

8.
9.
10.
11.
12.
Oxygenated blood
Left atruim
Mitral (bicuspid) valve
Left ventricle
Aortic semilunar valve
Aorta

Coronary arteries supply blood to the
myocardium from the aorta and returning to
the right atrium.
Anatomy of the Heart

Cardiac cycle
Single cycle includes all the
happens within the heart during a
single heartbeat.
 Systole = phase of contraction
 Diastole = phase of relaxation


Blood volume

Total amount of blood and plasma
within the body
Anatomy of the Heart

Cardiac conduction
Transmission of electrical impulses.
 SA node

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Acts as the natural pacemaker.
AV node
 Atrioventricular bundle

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Bundle of his
Purkinje fibers

Myocardium
Fetal Circulation


Fetal heart development begins just
before the end of the 3rd week of
gestation.
Structures:

Umbilical cord

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2 arteries
1 vein
Ductus venosus
Ductus arteriosus
Foramen ovale
Cardiothoracic Surgery

Fetal Circulation
Operative Pathology

Pectus excavatum
Most common congenital deformity.
 Posterior sternal depression.

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Pneumothorax

Accumulation of air in the pleural
cavity.
Open pneumothorax
 Tension pneumothorax
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Cardiothoracic Surgery
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Thoracic Trauma (penetrating)
Operative Pathology
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Thoracic aortic aneurysm
Coronary artery disease
Congenital heart defects

Ventricular septal defect

Abnormal opening between the right
and left ventricle.
Diagnostic Procedures

Bronchoscopy
Evaluation of the bronchi and lungs
 Not considered a sterile procedure
 Rigid

Viewing of the trachea and primary
bronchi
 Used for removal of foreign objects in
children.


Flexible

Viewing of upper, middle, and lower
bronchi.
Cardiothoracic Surgery
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Cardiothoracic Surgery
Instrumentation
Cardiothoracic Surgery

Cardiothoracic Surgery
Instrumentation
Common Procedures
 Thoracoscopy
 Thoracotomy
 CABG
 Valve
replacement
Cardiothoracic Surgery
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Thoroscopy
Cardiothoracic Surgery
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Thoroscopy
Cardiothoracic Surgery
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Coronary Artery Bypass Grafting
Cardiothoracic Surgery
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Aortic Valve Replacement
Cardiothoracic Surgery

Aortic Valve Replacement
Cardiothoracic Surgery
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Aortic Valve Replacement
Cardiothoracic Surgery
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QUESTIONS!