SU26.{1,3-4} | Cardiothoracic Surgery — Glossary

Congenital lesions with a left-to-right shunt (PDA, ASD, VSD) in which oxygenated blood recirculates through the lungs; the child is pink, not blue.

The commonest lung cancer overall, typically peripheral and the non-small-cell subtype least strongly tied to smoking (though still smoking-related).

A tumour marker raised in many malignant germ-cell tumours, used to support diagnosis and monitor treatment of mediastinal teratomas.

The compartment in front of the heart and great vessels; its characteristic masses are the four T's — thymoma, teratoma/germ-cell tumour, retrosternal thyroid and lymphoma.

A clamp placed across the aorta to isolate the heart from the circulation during open cardiac surgery.

A hole in the atrial septum causing an acyanotic left-to-right shunt; closed surgically or by device.

Beta human chorionic gonadotrophin, a tumour marker raised in certain germ-cell tumours of the mediastinum.

An artificial heart valve made from animal or human tissue that does not require long-term anticoagulation but degenerates over roughly 10-15 years.

Cancer arising from the bronchial epithelium of the lung — the overwhelming majority of primary lung cancers, divided into small-cell and non-small-cell types.

A benign developmental cyst of the middle mediastinum derived from the foregut/airway, removed if symptomatic.

Endoscopic inspection of the airways used to visualise and biopsy a central lung tumour for tissue diagnosis.

A high-potassium solution that arrests the heart in diastole, giving the surgeon a still, bloodless operative field.

The heart-lung machine that temporarily takes over the heart's pumping and the lungs' gas exchange, allowing the heart to be stopped and operated on.

The definitive cross-sectional imaging for a mediastinal mass, localising it to a compartment and showing its density and relationship to vessels and airway.

Catheter-based contrast imaging of the coronary arteries that maps the site and severity of narrowing and guides the choice between medicine, angioplasty and bypass surgery.

Operation that uses a graft (internal mammary artery, vein or radial artery) to carry blood past a blocked coronary artery, restoring blood supply to the heart muscle in ischaemic heart disease.

Percutaneous sampling of a peripheral lung mass under CT guidance to obtain a tissue diagnosis.

Congenital lesions with a right-to-left shunt (e.g. Tetralogy of Fallot) in which deoxygenated blood reaches the body, making the child blue.

Secretion of adrenocorticotrophic hormone by a tumour (classically small-cell lung cancer), producing Cushing's syndrome features.

Irreversible pulmonary hypertension that reverses a long-standing left-to-right shunt into a right-to-left shunt, causing cyanosis and contraindicating defect closure.

Assessment — especially of lung function and cardiac status — of whether a patient can tolerate lung resection, since enough functioning lung must remain afterwards.

Coughing up blood, an important warning symptom that warrants investigation for lung cancer, especially in a smoker.

Ptosis, miosis and anhidrosis on one side from interruption of the sympathetic supply, classically caused by a Pancoast tumour.

The internal thoracic artery, the most durable conduit for coronary bypass because grafts using it stay patent for many years.

An undifferentiated non-small-cell lung cancer subtype.

Surgical removal of a lobe of the lung, the commonest curative resection for localised non-small-cell lung cancer in a fit patient.

A durable artificial heart valve made of synthetic materials that lasts decades but is thrombogenic and requires lifelong warfarin anticoagulation.

Hodgkin or non-Hodgkin lymphoma involving the mediastinum; a medical disease treated by chemotherapy and radiotherapy, with surgery limited to biopsy.

An endoscopic surgical procedure to inspect and biopsy mediastinal lymph nodes and masses for tissue diagnosis.

The central compartment of the chest between the two pleural cavities, containing the heart, great vessels, trachea, oesophagus, thymus, lymph nodes and nerves.

The compartment containing the heart, pericardium, great vessels and many lymph nodes; characteristic masses are lymphadenopathy and developmental cysts.

An autoimmune disorder with antibodies to the acetylcholine receptor causing fatigable muscle weakness, ptosis and diplopia; classically associated with thymoma.

Tumour arising from nerve tissue (schwannoma, neurofibroma, ganglioneuroma, neuroblastoma) characteristically found in the posterior mediastinum.

The group comprising adenocarcinoma, squamous cell and large-cell carcinoma; surgically resectable for cure when localised and the patient is fit.

Component of the cardiopulmonary bypass circuit that adds oxygen to and removes carbon dioxide from the blood, performing the lung's function.

A lung cancer at the apex that invades the sympathetic chain (causing Horner's syndrome) and the lower brachial plexus (causing shoulder and arm pain).

Distant effects of a tumour caused by secreted hormones or hormone-like substances rather than direct invasion — e.g. SIADH and ectopic ACTH in small-cell, hypercalcaemia in squamous cell lung cancer.

Persistence of the fetal ductus arteriosus after birth, producing an acyanotic left-to-right shunt; treated by ligation or device closure.

Combined positron-emission tomography and CT imaging used in lung cancer staging to detect occult nodal or distant metastatic disease.

Surgical removal of an entire lung, used for more central or extensive resectable non-small-cell lung cancer.

The compartment behind the heart containing the oesophagus, descending aorta and sympathetic chain; its characteristic masses are neurogenic tumours.

A tumour-secreted peptide causing hypercalcaemia, characteristically in squamous cell carcinoma of the lung.

Downward extension of a thyroid goitre behind the sternum into the anterior mediastinum, removed surgically if it causes compression.

Syndrome of inappropriate antidiuretic hormone secretion, causing low serum sodium; a paraneoplastic feature characteristic of small-cell lung cancer.

A central, neuroendocrine, strongly smoking-related lung cancer that is usually disseminated at diagnosis and treated with chemotherapy and radiotherapy rather than surgery; classically causes SIADH and ectopic ACTH.

A typically central, strongly smoking-related non-small-cell lung cancer that may cavitate and classically causes hypercalcaemia via parathyroid-hormone-related peptide (PTHrP).

Blockage or compression of the superior vena cava, usually by a mediastinal malignancy, causing facial and neck swelling, distended non-pulsatile neck veins, plethora and chest-wall collateral veins.

Endovascular placement of a stent in the superior vena cava to relieve obstruction rapidly while the underlying cause is treated.

An anterior mediastinal tumour arising from germ cells; malignant forms may raise alpha-fetoprotein and beta-hCG and are treated mainly with chemotherapy.

The commonest cyanotic congenital heart lesion, comprising ventricular septal defect, pulmonary stenosis, overriding aorta and right ventricular hypertrophy; corrected by VSD closure and relief of right ventricular outflow obstruction.

Mnemonic for the characteristic anterior mediastinal masses: Thymoma, Teratoma (germ-cell tumour), retrosternal Thyroid and 'Terrible' lymphoma.

Surgical removal of the thymus, used to treat a thymoma and to improve associated myasthenia gravis.

A tumour of the thymus and the commonest primary anterior mediastinal tumour in adults; importantly associated with myasthenia gravis and treated by thymectomy.

The system that stages cancer by the local Tumour, regional lymph Node involvement and distant Metastasis; it determines prognosis and whether cure (including surgery) is possible.

Surgical reconstruction of a patient's own diseased valve (commonly the mitral valve), preserving native tissue and avoiding a prosthesis where feasible.

A leaky valve that allows blood to flow backwards, volume-overloading the chamber and eventually the ventricle.

Narrowing of a heart valve that obstructs forward blood flow, overloading the chamber behind it.

A hole in the ventricular septum causing an acyanotic left-to-right shunt; closed surgically or by device, and a component of Tetralogy of Fallot.

Lifelong oral anticoagulant therapy, monitored by INR (target ~2.5-3.5 for mechanical valves), needed to prevent thrombosis on a mechanical prosthesis; teratogenic, so avoided in pregnancy.