Case studies involving the thorax, mediastinum, embryology of the heart & circulatory systems
Anatomic and clinical reviews that will include basic symptoms and findings, diagnosis & treatment
Tufts University school of Medicine
Joan F. Tryzelaar, M.D., F.A.C.S, F.A.C.C.P.
Before we go on to congenital heart problems, it is good to review how to get into the chest:
You have just been invited to participate in an operation. The surgeon plans a posterolateral thoracotomy to enter the chest. He will tell you that he plans entry via the 6th intercostals interspace(Pearl: found two finger widths below the tip of the scapula).
In 1995 Topol first described what vascular surgeons have known for many years:
The pressure drop in a fluid flowing through a long cylindrical pipe such as a stenotic artery becomes functionally significant when the obstruction exceeds 70%, first described in the Poiseuille law in 1846.
As was stated in Topol's paper: “Accordingly, before the residual stenosis in an infarct vessel is addressed, there should be demonstration of either spontaneous or provocable signs of ischemia… clinicians and investigators rely excessively on angiography for clinical decision-making… Procedures should not be performed solely to improve the luminal appearance—so-called coronary “cosmetology".
This principle was tested with the PCI Fractional Flow Reserve FAME 1&2 trials: