Cardiothoracic Surgery – Farrer Park Hospital
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What is Cardiothoracic Surgery?
Cardiothoracic surgery is the medical specialty involved in the surgical treatment of diseases affecting the organs inside the chest -- mainly the heart and lungs.
Conditions
Coronary Heart Disease
Coronary heart disease occurs when plaque is built up inside the wall of the coronary arteries. The plaques hardens over time, hence narrowing the lumen, and this inhibits the flow of oxygen-rich blood to heart muscle. Coronary disease can lead to heart attack, or heart failure when the heart muscle weakens. 
 
Valvular Heart Disease
Heart valves control the direction of flow of blood between different parts of the heart. Over time, because of aging or congenital reasons, they lose their function because of their inability to open and close. This leads to either narrowing of the valve or leakage. 
 
Pneumothorax (air in chest cavity)
The chest area surrounding the lungs is a vacuum, allowing easy expansion of the lungs when breathing in. Pneumothorax is the condition when air enters this vacuum either through an outside wound in the chest wall or when ribs are fractured and the broken tips puncture lung tissues, allowing air to leak into the surrounding chest cavity. Depending on the severity, pneumothorax will cause the lungs to collapse to some degree. Symptoms include chest pain that appear suddenly. You could also experience shortness of breath, rapid heart rate, and fatigue.  
 
Pleural effusion is an excessive buildup of fluid between your lungs and chest cavity. While there is always a small amount of liquid inside your lungs so as to coat the membranes (pleura) that line the outside of your lungs and lubricate the chest cavity to aid in breathing, the pleura may create too much fluid when it is irritated or infected.
 
There are certain types of cancer, such as lung, breast, and ovarian cancers that can cause pleural effusions, as well as infection due to pneumonia. Common symptoms of pleural effusion include dry cough, breathing difficulties, and chest pain.
 
Empyema
Empyema is a condition in which pus accumulates in the area between the lungs and the inner surface of the chest wall. The condition usually develops after a bout of pneumonia. You will have difficulty breathing. Pus in the pleural space cannot be coughed out.
 
Emphysema
Emphysema is a disease of the lungs most commonly caused by smoking. The walls of the air sacs of the lung breaks down causing them to become abnormally enlarged and function poorly making it more difficult for you to breathe.
 
Lung Cancer
Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. They inhibit the normal functioning of lung cells which provides oxygen to the body via the blood.
 
Treatments

Coronary Heart Diseases can be treated with a ​Coronary Artery Bypass Graft (CABG), an operation carried out to treat people with coronary heart disease, whose blood flow to heart muscle are severely narrowed or blocked. It involves taking healthy blood vessels from other parts of the body and attaching them to the coronary arteries past the blockages. The blood is then able to ‘bypass’ the blockage.

Heart valves can be repaired or replaced with surgery. The aim is to try and save as much of the valve as possible.

Surgery can help to alleviate the symptoms for Pneumothorax. The chest wall is surgically repaired by closing the opening to the outside and the excess air is withdrawn from the chest cavity using a needle and syringe or a special valve.

Generally, treatment for Pleural Effusion involves draining the fluid from the chest cavity, either with a needle or a small tube inserted into the chest. You will receive a local anesthetic before this procedure, which will make the treatment much less painful. You may have to return for this treatment if fluid re-collects.

In Empyema, the pus needs to be drained by a needle, chest drain or surgery, or by decortications, which is a surgical procedure that removes any restrictive layer to allow the lung to re-expand. This surgery can be done using small incisions (minimally invasive surgery).

Emphysema cannot be cured but medications such as Brochodilators, Steroids and antibiotics can help to improve symptoms. Your specialist may also recommend therapy to learn breathing exercises or techniques, manage weight or increase oxygen intake through tubing. Surgery is another option to reduce lung volume or for lung transplant.

Video Assisted Thoracosopic Surgery (VATS) has been used to perform diagnostic procedures such as lung, and tumor biopsies. Surgeons can sometimes use the VATS keyhole surgery to remove very small, early lung cancers. The surgeon makes 1, 2 or 3 small incisions (measuring 5-12 mm each) on the side of the chest and is able to view the chest cavity with a miniature fiber optic camera as well as insert the surgical tools through the cuts to carry out the surgery.

Some other operations remove particular areas of the lung. A wedge resection removes an area of the lung that includes part of one or more lobes. A segmentectomy removes areas of the lung along with their veins, arteries and airways. These surgeries can be done if the cancer has been diagnosed early and is localized. Lobectomy is the removal of one lobe of the lung. Your surgeon will recommend this type of operation if they think the cancer is just in one part of one lung. It is the most common type of operation for lung cancer.

 

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