Uems-cardiothoracicsurgery.com



UEMS Section of Cardiothoracic SurgeryCARDIAC/CARDIOTHORACIC/CARDIOVASCULAR SURGERYSYLLABUSPhysiologyMyocardial cellular physiologyElectrophysiologyPhysiology of congestive heart failureAnatomyHeart, pericardium and great vesselsCoronary anatomyValvular anatomyAnatomy of the peripheral vascular systemAnatomy of cardiac innervationPathologyAtheroma, medial necrosisMyocardial infarction and complications Intrinisic myocardial disorders EndocarditisPericarditisTumors of the heart Sequelae of chest wall and mediastinal radiationPharmacologyDrugs used in the treatment of hypertension, heart failure, and anginaInotropes, vasodilators and vasoconstrictorsAnticoagulants, antiplatelet drugsMicrobiologyAntibiotic prophylaxis for cardiac surgeryImagingEchoCardiac cathCT-SCANMRIGeneral Patient ManagementDiagnosis, evaluation and treatment of heart diseaseRisk assessment (including when not to operate)Cardiopulmonary resuscitation (open chest)Cardiac arrhythmias – diagnosis and managementCardiac rehabilitationManagement of complications of cardiac surgeryMedian sternotomyPeripheral arterial and venous cannulation techniqueWound infection and sternal disruptionCardiac tamponadeInterpretation of:Hemodynamic dataECG including exercise dataCoronary angiographyCardiac cath hemodynamicsEcho including 2D, Doppler and transthoracic, stress echoNuclear cardiologyCardiac MRICT angiography CARDIOPULMONARY BYPASS, MYOCARDIAL PROTECTION, AND CIRCULATORY SUPPORTMetabolic response to CPBTemperature regulationPrinciples of myocardial preservationPhysiology of balloon pumpAnatomy of femoral triangle and thoracic inlet and neckPrinciples and practice of CPBRelevant equipment and technology and its applicationMonitoring during CPBPriming fluids and hemodilutionAcid base balance – pH and alpha statNeuropsychological consequences of CPBCell salvage and blood conservationCardioplegia solutions and delivery modesNoncardioplegic techniques of preservationIntra-cardiac balloon pump – indications for use, patient selection and complicationsCoordination of perfusionist, anesthesiologist, and surgeonPatient selection for mechanical circulatory supportManagement of balloon pumpWeaning from bypass and decannulation Recognize and manage acute complications of CPB Cannulation and institution of CPBRepeat sternotomy with pericardial dissection, cardiac mobilizationFemoral or axillary cannulation and decannulationISCHEMIC HEART DISEASE Diagnosis, investigation and treatment of ischemic heart diseaseResults of surgery: survival, graft patency, recurrenceGuidelines for myocardial revascularizationArterial revascularizationRole of PCI and nonoperative treatmentHybrid approachesComplication of MI and ischemic heart disease: VSD, mitral regurgitation, aneurysmOn and off pump techniquesPreop cardiovascular assessment including general history and exam, conduit assessment, drug history, comorbidities, and risk assessmentImaging interpretationPostop management including complicationsMammary artery/radial artery harvest, venous conduit procurementProximal and distal coronary anastomosis Repeat coronary artery surgeryMinimally invasive conduit procurementCombined coronary and carotid interventionHEART VALVE DISEASEAnatomy of cardiac chambers and valves Valve physiology and hemodynamicsCalculation of valve area and regurgitant fractionPathophysiology of valve incompetence and stenosisConsequences of valve disease on cardiac function and morphologyPathophysiology of mixed valve disease and combined valve pathologyDiagnosis, investigation and assessment of valvular heart diseaseDetermination of need and timing of surgical intervention valve diseaseCardiovascular system and general history and exam including drug history, identification of comorbidity and risk assessmentEcho interpretation (thoracic and transesophageal)Combined valvular and ischemic heart diseaseEndocarditis and prosthetic valve endocarditisIndications for operative management including: valve replacement/repair (mechanical, biologic stented and stentless grafts, homografts and autografts)Guidelines for valvular heart disease and endocarditisValve design: materials, anticoagulation and biomechanicsResults of surgery – survival, long-term functional status, valve thrombosis, endocarditis, bleedingAlternative surgical approaches to valve surgery including thoracotomy, transseptal/transapical approaches, minimal access surgery, and percutaneous approachesManagement of postop heart valve patient including complicationsMedical management of endocarditis Valve selectionLong-term anticoagulation and antibiotic prophylactic guidelinesAortic valve and root surgery: repair and replacementMitral valve surgery: repair and replacementTricuspid valve surgery: repair and replacementPulmonary valve and right ventricular outflow tract surgery: repair and replacementCombined valve and graft surgerySurgical strategies for managing small aortic rootGREAT VESSEL DISEASEVascular pathology (including atherosclerosis, inherited and acquired disorders)Blood supply of the spinal cord Spinal cord and cerebral preservation Traumatic aortic transectionResults of surgery – survival, complication ratesRole of endovascular stentingMedical management of great vessel diseaseKnowledge of thromboembolic diseaseInterpretation of CT scan, MRI, aortographyMedical management of great vessel disease Selection of patients for surgeryManagement of postop patients including complicationsMedical and surgical management of venous obstructive diseaseMedical and surgical management of acute and chronic pulmonary embolic diseaseIntraoperative monitoringSpinal cord and cerebral protectionBypass and non-CPB strategies for major aortic surgerySurgery for acute dissection of thoracic aortaAortic root replacement for acute and chronic aortic root diseaseComplex aortic surgery, including aortic arch surgery, descending aortic and thoraco-abdominal aortic surgeryEndovascular stentingPulmonary embolectomyGreat vessel venous reconstructionPERIPHERAL VASCULAR DISEASEVascular exam (including interpretation of ankle: brachial index)Diagnosis and management of DVTDiagnosis and management of acute limb ischemiaDiagnosis and management of visceral ischemiaCarotid artery disease and transient ischemic attacksAneurysmal diseaseLeg ulcerationAtherosclerotic arterial disease - aortic - acute and chronic limb ischemia Embolic and thrombotic arterial diseaseVenous insufficiencyDiabetic ulcerationPseudoaneurysmsComplication of vascular accessSaphenous vein harvestVascular anastomosisEmbolectomyFasciotomyCARDIAC CONDUCTION SYSTEM DISORDERSAnatomy of normal conduction pathways Anatomy and influence of sympathetic and parasympathetic nervous system on cardiac conductionCharacteristics of atrial conduction disorders (sinus node dysfunction, atrial flutter, atrial fibrillation, Wolf-Parkinson-White syndrome, AV Node Reentry) Characteristics of ventricular conduction disorders [ventricular tachycardia (monomorphic vs. polymorphic), ventricular fibrillation, left bundle branch block, right bundle branch block]Risk factors for post-operative atrial fibrillationAdverse consequences of atrial and ventricular arrhythmias and current medical therapiesIndications for pacemaker placement for atrial and ventricular disordersIndications and timing for automatic implantable cardiac defibrillatorsIndications for epicardial lead placementIndications for cardiac resynchronization therapyComplications of intravascular leads (perforation, infection, great vessel stenosis) Indications for and complications of catheter ablation Select appropriate patient and lesion set for lone and concomitant surgery for atrialfibrillation and define the success ratesManage anti-coagulation and anti-arrhythmic medication after surgery for atrial fibrillationManage post-operative atrial fibrillationComplications of transvenous lead extractionDetermine the need for emergent operation after complications of ablation and lead extractionSelect appropriate patients for the surgical treatment of cardiac dysrhythmias Manage temporary cardiac pacing in the peri-operative settingImplantation of pacemakers and leadsAtrial fibrillation operationDISEASES OF THE PERICARDIUM AND MYOCARDIUM. CARDIAC TUMORSAnatomy of the pericardiumPathology of the pericardium (benign, malignant, inflammatory)Pathophysiological consequences of pericardial constriction and tamponadeClinical and imaging techniques used to detect pericardial disease Pericarditis (primary and post pericardiotomy)Needle aspiration of pericardial fluid with echo guidancePericardial window (subxiphoid, thoracoscopic approach)Pericardiectomy for relief of constrictionMaterials used for pericardial replacementComplications following pericardial surgeryIndications for pericardial reconstructionInterpretation of laboratory, physiological and imaging techniques, including echoRecognition and assessment of pericardial tamponade and constrictionRecognition of pericardial herniation and cardiac strangulationPostop management of patients following pericardial surgeryBenign and malignant cardiac tumorsManagement of cardiac tumors Diagnosis and management of HOCM HEART FAILURE AND CARDIAC TRANSPLANTATION Etiology and natural history of heart failureModes of action and interaction of commonly used drugs in heart failureEvaluation and management of advanced heart failureIndications for acute and chronic mechanical assistancePathophysiology of nonpulsatile flowCardiovascular and general history and exam: preoperative assessment for cardiac transplantationIndications and assessment for heart transplantationAcute and chronic cardiac rejectionResults of heart transplantation and non-transplant interventions for heart failureManagement of brain-dead donorDonor retrievalManagement of postoperative transplant patient including complicationsImmunossupressant therapyDiagnosis and treatment of device failureManagement of acute post-cardiotomy heart failureCardiac transplantation techniqueSurgical revascularization for ischemic cardiomyopathyVentricular remodeling surgeryMitral valve repair for heart failureProvision and management of acute mechanical ventricular supportExtracorporeal and intracorporeal ventricular assistance devicesCARDIOTHORACIC TRAUMAThe mechanism and patterns of injury associated with blunt, penetrating, anddeceleration injuries to the chest Indications and use of appropriate investigations in thoracic trauma management Indications for thoracotomy in traumaCare of blunt, penetrating and deceleration injuries to the chestDiagnosis and management of immediately life threatening situations:obstructed airway, tension pneumothorax, massive hemothorax, open chest wound, flail chest, and cardiac tamponadeDiagnosis and assessment of potentially life threatening situations:lung contusion, bronchial rupture, blunt cardiac injury, intrathoracic bleeding,esophageal injury, simple pneumothorax and major vascular injuryPericardiocentesis and subxiphoid window for tamponadeVarious approaches to expose thoracic traumaRepair of cardiac injuriesRepair of aortic transectionRepair of other great vessel injuriesPRINCIPLES OF THORACIC SURGERYOpen versus minimally invasive approaches to thoraxEarly and late complications of thoracic incisionsManagement of post-thoracic surgical complicationsPostoperative management of pain controlTreatment of cardiac arrhythmiasPhysiotherapy and rehabilitationUnderstanding thoracic-specific ventilatory techniques (e.g., lung isolation)Introduction to benign and malignant tumors of trachea, bronchus, lungPrinciples of lung resections Etiology, pathology and physiology of COPDSmoking cessation measures and outcome Interpretation of pulmonary function testsChest drains insertion, management, removal Introduction to congenital, benign, infectious and malignant (primary and secondary) conditions of the mediastinumCONGENITAL HEART DISEASEPhysiologyHemodynamics; physiology and measurement including shunt calculations, PVR, SVR determinations Physiology of Left-to-Right shunts and Right-to-Left shunts Physiology of pulmonary vasculature and changes with developmentBasic conduction disordersAcid base balance (including Ph stat and alpha stat CPB mgmt)Physiology of pediatric cardiopulmonary bypass including hypothermia, low-flow, and circulatory arrest.AnatomyBasic embryology of the heart, lungs, great vesselsCoronary anatomy and variantsLocation and course of the conduction system in congenital heart diseaseAnatomy as it pertains to vascular conduits including aortopulmonary shuntsBasic anatomy of atrial septum and ventricular septumBasic concepts of cardiac position, situs, atrioventricular and ventriculoarterial connectionsPathophysiolologyBasic concepts of volume and pressure overload Mechanisms of cyanosisManifestations of congestive heart failure in infants and childrenPharmacologySpecific drugs used in the treatment of congenital heart disease (beta blockers, ACE inhibitors, Digoxin, Diuretics, PGE1, nitric oxide, systemic vasodilators)Specific dosing and application General indications and use of inotropes, anti-arrhythmic drugs, hemostatic drugs,antiplatelet, anticoagulant and thrombolytic drugs, analgesics, antibiotics,anesthetic agents, and vasodilators (systemic and pulmonary) in the pediatricpopulationCongenital Heart Disease Data InterpretationRoutine hematology and biochemical investigationsChest radiograph and ECGCardiac catheterization data including interpretation of hemodynamic data, shunt and resistance calculationBasic congenital heart disease imaging (Echo, MRI, CT) interpretationDiagnosis, assessment, and treatment of common congenital heart diseaseCollaborative and complementary role of interventional cardiologyRisk assessment and stratificationBasic pediatric intensive care to include ventilator managementPerioperative management of adults and children following congenital heart surgeryMechanical assist (IABP, VAD, ECMO)Indications for heart or lung transplantation referralManagement of complications of surgeryCardiopulmonary resuscitationDiagnosis and treatment of common congenital cardiac arrhythmiasWound infection and sternal dehiscenceSternotomy Thoracotomy Preparation for and management of cardiopulmonary bypass including partial bypassBasic ECMO techniques, cannulation, and management.Anatomy, pathophysiology, natural history, management, and results of the following conditions or procedures:Patent ductus arteriosusAtrial septal defectVentricular septal defectCoarctationPA banding and shuntsTransposition of the great arteries/arterial switch procedureTetralogy of FallotVascular ringFunctional single ventricle leading to single ventricle pathway and principles of treatment (Fontan procedure)Congenital aortic stenosis/insufficiency (Konno, Ross procedure)Rastelli procedureHypoplastic left heart and Norwood procedureTruncus arteriosusDouble outlet right ventricleVSD, Pulmonary atresia, and MAPCAsPulmonary atresia and intact septumPartial and complete atrioventricular septal defectsMitral valve diseaseTricuspid valve disease including Ebstein’s anomalyInterrupted aortic archTotal anomalous pulmonary venous drainageExtra Corporeal Membrane OxygenationTransplantation – Heart and Lung ................
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