Glossary of Cardiac Surgery Terms

ABLATION

A surgical or electrophysiological technique used to repair interrupted abnormal electrical pathways in the heart. These abnormal pathways can be the cause of abnormal heart rhythms, such as Atrial Fibrillation or atrial flutter. Ablation can be accomplished with a variety of energies, and through a variety of surgical approaches.

ACHALASIA

A condition where the lower esophageal sphincter cannot relax or open upon swallowing, resulting in the inability to pass food from the esophagus into the stomach.

ANASTOMOSIS

The connection between two blood vessels or two hollow organs, such as the intestines.

ANEMIA

A condition in which the oxygen-carrying component of blood, a protein called hemoglobin, falls below normal levels. Anemia can be caused by many factors, such as blood loss, chronic disease states such as renal failure, and secondary to some medications such as chemotherapy. Treatment of the anemia is determined by the cause of the condition and the severity. Treatments may range from something as simple as iron supplements to a blood transfusion.

ANEURYSM / AORTIC ANEURYSM

Aneurysm refers to an abnormal expansion of an artery. Aortic aneurysm refers to an abnormal expansion of a section of the aorta, which is the main artery of the body. Aneurysms result from a weakened part of the artery wall expanding over time to an abnormal size. To use a non-medical example, an aneurysm is similar to a weak spot on a tire or hose that has started to balloon out and expand. Aneurysms can be caused by a variety of conditions, including high blood pressure, a weakness in the artery wall, or a congenital abnormality of the artery walls. The main risk of aneurysm is rupture, which, if not treated in time, can be fatal.

ANGINA / ANGINA PECTORIS

The pain, discomfort, or symptoms associated with the heart muscle not getting enough blood and oxygen. Angina is not typically a sharp pain like that associated with, for example, hitting your thumb, but more of a pressure-like sensation. The classic description of angina is when the patient experiences pressure, usually on the front of the chest just underneath the breast bone, or to the left of the breast bone. The discomfort can travel to the neck or down the arm. Sometimes the patient will describe some numbness of the arm. The pain is usually brought on by some kind of stress or exercise and often dissipates with rest. Angina, however, can also be confused with indigestion, gallbladder symptoms, or in some cases, flu-like symptoms. Angina is not the same as having a heart attack but can be a waring sign of a potential heart attack.

ANGIOGRAM

An x-ray test in which the radiologist injects a dye into a blood vessel and takes an x-ray while the dye is being injected. The angiogram is used to distinguish the vascular anatomy of a part of the body, such as the heart. The dye, sometimes referred to as "contrast", does not actually color the blood vessels, but instead blocks x-rays from passing through it, thereby helping to create an image of the artery or vein on an x-ray. Some angiograms are done with still pictures, while others, like heart angiograms, are done using moving pictures.

ANGIOPLASTY / BALLOON ANGIOPLASTY

The term used to describe a procedure that opens a blocked or narrowed artery. During an angioplasty, a small wire, under x-ray guidance, is passed through a narrowed artery. A small sausage-shaped balloon is then advance over the guide wire into the narrowed section of artery, again using x-ray guidance. The balloon is then inflated to dilate the narrowed section of the artery. Once the artery is dilated, a small amount of dye is injected (angiogram) to confirm the successful dilatation.

ANTIBIOTICS

Drugs that are used to treat infections. Examples of well-known antibiotics include penicillin, tetracycline, and amoxicillin. One of the first antibiotics, penicillin, was a by-product of a mold growing on bread. Today many antibiotics are synthetic, but some are still made using micro-organisms to produce the drug. Depending on the severity of the infection, antibiotics may be given by mouth or by intravenous injection.

ANTIBODY

Important in the body’s defense against infections, an antibody is a blood protein that is produced by the body’s immune system in response to a foreign body or foreign protein. These foreign bodies/proteins include bacteria, viruses, as well as other foreign tissues, such as a transplanted heart, lung, liver or kidney. Immunization against measles, mumps, and chicken pox is done to expose the body to the inactivated organism so the body can manufacture antibodies that will, in the future, recognize the live organism and help the body fight off the infection. Antibodies are very specific, so an antibody that is protective against measles won’t fight off tetanus. In transplantation surgery, some medications are used to blunt the patient’s immune system response to the foreign transplanted organ. Rejection of the transplant is often the result of antibodies that are formed to combat the perceived foreign tissue.

ANTISEPTICS

Substances that hinder the growth and activity of microorganisms, or germs. In surgery, the use of antiseptics is essential, especially in disinfecting instruments and other materials used in operations.

AORTA

The human body has two main kinds of blood vessels, arteries and veins. The aorta is the main artery of the body. The arteries, with only two exceptions, transport oxygen-rich blood from the heart and lungs to the rest of the body. The veins transport the blood that has been used by the body’s organs to the heart and lungs so that it can be re-oxygenated and pumped back to the rest of the body. The aorta starts just above the heart and travels down to about the level of your navel. There, it divides into smaller branches, which then progress down the lower extremities. The aorta is the largest artery of the body and can be divided into 4 sections: the ascending aorta, the aortic arch, the descending thoracic aorta, and the abdominal aorta.

AORTIC VALVE

The aortic valve is one of the 4 valves located in the human (mammalian) heart. All of the valves in the heart are one-way valves and, if functioning normally, allow blood flow in only one direction. The aortic valve is located at the beginning of the ascending aorta and allows newly oxygenated blood to leave the left ventricle and be transported to the body’s organs. The aortic valve is typically made up of three leaflets, which open and close with the heart cycle. The aortic valve can cause problems by either becoming too narrow, a condition known as aortic valve stenosis. If the valve leaflets do not close properly, the aortic valve can leak and no longer function as a one-way valve, which is referred to as aortic valve insufficiency or regurgitation. Aortic stenosis or insufficiency can be treated successfully with surgery.

ARRHYTHMIA

The heart beats or pumps at a certain speed and in a certain way, depending on the needs of the patient’s body. When the heart is pumping normally, the heart is said to be in a normal (sinus) rhythm. Any deviation from a normal rhythm is defined as an arrhythmia, where the heart is beating too fast, too slow, beating irregularly or a combination of these abnormal rhythms. Arrhythmias are generally divided between atrial arrhythmias such as atrial fibrillation and ventricular arrhythmias. Most arrhythmias can be treated with medications, but some require surgery. While most arrhythmias are not life-threatening, some, such as ventricular fibrillation, are fatal if not treated quickly. Arrhythmias can be secondary to many causes, such as heart attack, medications, and electrolyte imbalances.

ARTERIOSCLEROSIS / ATHEROSCLEROSIS

A generalized condition affecting the walls of the arteries. It is commonly referred to as "Hardening of the arteries". The cause of arteriosclerosis is not 100% defined, but major risk factors for developing arteriosclerosis include genetics, family history, high blood pressure, high cholesterol, poor diet, cigarette smoking, and lack of exercise. Arteriosclerosis is a slow process that begins early in life and develops over time. The end result is usually narrowing of the arteries by a build up of minerals and fatty deposits. The narrowing can progress to occlusion (obstruction or a closure of a passageway or vessel). Heart attacks and strokes are often the end result of severe arteriosclerosis of the arteries which supply the heart and brain with oxygen-rich blood.

ASPIRATION

The act of taking in a breath. However, the term aspiration is more commonly used to define the act of removing fluid or air from a body cavity using suction. Example: "We aspirated 100 cc’s of fluid from the chest." Aspiration may also refer to a condition that occurs when a patient vomits and some of the stomach content is sucked into the lungs by the patient when taking a breath. Example: "The patient was drunk, vomited and aspirated." Aspiration of gastrointestinal contents can cause a severe pneumonia.

ASTHMA

A disorder of the upper respiratory tract involving the lungs and the bronchi, characterized by wheezing, coughing, choking and shortness of breath. Asthma is a symptom and not a disease; therefore remedial measures involve locating, isolating and eliminating the cause rather than treatment of the condition itself.

ATELECTASIS

A term used to describe a complete or partial collapse of a portion of the lung. The lungs are made up of millions of tiny air sacs called alveoli. Different conditions can cause these alveoli to collapse, which can result in impaired breathing and can lead to pneumonia. Atelectasis can be detected on chest x-ray and is treated by taking measures to re-expand the collapsed alveoli. These measures may range from encouraging the patient to take slow deep breaths, to mechanical ventilation.

ATRIAL SEPTAL DEFECT (ASD)

A congenital, abnormal opening between the left and right atria of the heart. The heart is divided into the right and the left heart, and is made up of 4 chambers. On each side of the heart there is an atrium and a ventricle. The right atrium and the left atrium lay side by side and are separated by a muscular wall referred to as the septum. While in the mother’s womb, there is an opening in the septum, but at birth this opening quickly closes. An atrial septal defect is an abnormal opening in the septum. These should be closed since they can cause a variety of problems later in life. There are a variety of methods that can be used to close an ASD, depending on the size, location and the patient’s condition.

AUTOGRAFT

A surgical transplantation of any tissue from one part of the body to another location on the same individual.

BACTERIAL ENDOCARDITIS

A term used to describe an infection of a heart valve. Infections of heart valves can occur with the patients own native valve or with a valve that was previously implanted. Any of the 4 valves in the heart can become infected. The infection is usually secondary to some other infection in the body that has allowed bacteria into the blood stream. As the bacteria come in contact with the valve, the valve can become infected, especially if there is an abnormal surface or function of the valve tissue. Valve infections, i.e. endocarditis, can be treated with antibiotics, but often surgery is needed to remove the infected tissue and repair or replace the valve.

BEATING HEART SURGERY (OFF-PUMP CORONARY ARTERY BYPASS SURGERY)

A term used to describe coronary artery bypass grafting surgery in which the heart is allowed to continue beating normally while the bypasses are being performed by the surgeon and the surgical team. In most heart surgeries, including coronary artery bypass surgery, the heart is supported with the heart-lung machine. The vast majority of heart operations require that the heart is stopped so that the surgery can be performed. In recent years, technology and techniques have been developed that allow some patients to have coronary artery bypass surgery performed without the need for heart-lung machine support. In these cases the patient’s heart is not stopped, but is allowed to beat normally while the surgeon performs the required coronary artery bypasses. Not all patients are candidates for off-pump/beating heart coronary artery bypass surgery. The potential benefits of performing the surgery in this fashion are a quicker recovery, shorter hospital stay, and avoiding the potential physiological effects of being on the heart-lung machine.

BIOPSY

The removal and examination of tissue for diagnosis.

BLOOD

Blood is a fluid composed of cells and plasma that flow in the arteries and veins of the body. The cellular components of blood are red blood cells, white blood cells and platelets. Plasma is the fluid component of blood that carries red and white blood cells to the body’s organs as well as the nutrients and by-products of metabolism. Red cells, by far the most common cell component in blood, give blood its red color. Red cells contain hemoglobin, a protein that allows red cells to carry oxygen to the tissues and bring CO2 (carbon dioxide) back to the lungs, where the CO2 is exchanged for a new charge of oxygen. White cells are important in fighting infections, while platelets are crucial to proper clotting. Plasma, which contains many proteins, carries nutrients and helps bring the by-products of metabolism to the liver and kidneys for processing or elimination.

BLOOD PRESSURE

Measured in two levels, blood pressure is the degree of pressure exerted by the heart and arteries to keep the blood circulating in the blood vessels throughout the body. The maximum level, systolic pressure, records the force exerted in the arteries with each heartbeat or contraction, to propel the blood out of the left ventricle of the heart and into the aorta, the large artery. The minimum level, the diastolic pressure, records the relaxed phase of the heart, between beats. This pressure indicates to the doctor the condition of the small blood vessels or arterioles--that is, their ability to contract and keep the flow of blood constant throughout the body.

BLOOD TYPES

Also called the Landsteiner classification, the ABO blood groups classify blood into four types, A, B, AB, and O, and recognizes which blood groups can be safely mixed. Type O blood can give to all blood types, but can receive only from type O. AB blood type can give to only AB, but can receive from any group. Thus type O is sometimes called the universal donor and type AB the universal recipient. Type A can give to types A and AB and receive only from types A and O, and type B can give to types B and AB, and receive only from type B or O.

BRONCHIAL TUBES

Large, delicate tubes that carry air into the tiny branches and smaller cells of the lungs after this air has passed through the mouth, nasal passages, and windpipe (trachea).

BRONCHIECTASIS

A group of infectious disease conditions of the lungs characterized by dilatation of the lung’s airways, known as bronchi. The cause of bronchiectasis involves several predisposing factors, some of which are congenital and some of which are acquired secondary to a variety of infections. Acquired infections are the most common cause of bronchiectasis, especially infection acquired in childhood.

BRONCHITIS

An inflammation or infection of the lung’s airways, which are known as bronchi. In general, anytime an "itis" is attached to a medical noun, that implies that the organ is inflamed or infected. Examples: appendicitis, an inflammation of the appendix; gastritis, an inflammation of the stomach.

BRONCHOPNEUMONIA

An infection of the lungs involving the major air passages of the lungs. It is generally caused by a bacterial infection.

BRONCHOSCOPE

An instrument used to look inside the lung’s airways, which are known as a bronchus/bronchi or bronchiole, depending on the size of the airway. Most bronchoscopes consist of a flexible tube that is divided into three channels: the first channel has a fiberoptic channel that delivers light to the end of the scope; the second channel has an optic system that allows the physician to view inside the lungs; the third channel allows the physician to sample tissue, with biopsy tools or aspirate fluid from the different parts of the lungs. A bronchoscope is used to look inside the lungs to look for cancers, benign tumors, or infections, or to clear excessive fluids or mucous that may be blocking an airway. An alternative to the flexible bronchoscope, a rigid bronchoscope is a metal tube with the same components as the flexible bronchoscope, except the viewing channel is simply the opening in the metal tube. In general, most bronchoscopic exams are done using a flexible bronchoscope, with the patient under mild sedation.

BRONCHUS / BRONCHI / BRONCHIOLES

The airways of the lungs. When a person takes in a breath of air, the air travels through the nose or mouth, into the larynx, then into the trachea, which is the main passageway into the lungs. The trachea divides into a right and left main bronchus. Each major bronchus then subdivides into smaller airway passages referred to as bronchi. As the airway passages make their way out to the lung tissue, the passages become smaller and are referred to as bronchioles. Eventually the bronchioles terminate into small collections of air sacs known as alveoli, which is where the actual exchange of CO2 and Oxygen occur.

BYPASS

A procedure that diverts or reroutes the ordinary flow of blood. In heart surgery, bypass is most often used to describe two procedures or techniques: 1) Cardio-pulmonary bypass surgery, or 2) Coronary artery bypass surgery. Cardio-pulmonary bypass surgery is a technique where a heart-lung machine is used to support a patient’s heart and lung function during an open heart procedure. When cardio-pulmonary bypass is utilized, blood is drained from the body by a tube (cannula) that is usually placed in the right atrium, where all of the venous blood of the body is transported. The blood is drained to the heart-lung machine, which removes CO2, adds Oxygen, and then pumps the blood back to the patient, through plastic tubing from the heart-lung machine, usually into the patient’s aorta. By removing the blood from the right atrium, the heart and the lungs are "bypassed". And by the heart-lung machine pumping blood back to the body, the heart is "bypassed". The other use of the word "bypass" in heart surgery refers to coronary artery bypass surgery. In this procedure, a vein or artery from the patient’s body is used to construct an alternative pathway for blood to go around, or "bypass", a narrowing or blockage in the patient’s coronary artery. Hence the name "coronary artery bypass".

CARDIAC

The word "cardiac" is used as an adjective to describe a condition of the heart. Examples: Cardiac arrest refers to a heart attack, while cardiac surgery refers to surgery of the heart.

CARDITIS

An inflammation of the heart. May also be used with the term myocarditis, with "myo" referring to muscle, "cardio" (card) referring to the heart and "itis" referring to the inflammation. Myocarditis may be secondary to a number of diseases such as viral infections, or as a consequence of rheumatic fever.

CHEST DRAIN / CHEST TUBE

A hollow plastic tube that is inserted into the chest cavity to remove or allow the drainage of fluid from that portion of the chest cavity. Chest tubes are routinely placed into the chest after most open heart surgeries to allow the drainage of fluid from around the heart and lungs. They are removed when the drainage becomes minimal.

CHEST TUBE INSERTION

A procedure in which a chest tube is inserted, usually via a small incision between the ribs, into a portion of the chest cavity. Chest tubes are places to remove abnormal collections air, blood, or fluids that can compromise normal lung and heart function. The chest tubes are inserted under local anesthesia and sedation. The tubes are connected to a closed system and allow drainage or removal of the blood, fluid or air away from the heart and lungs, allowing resumption of normal function.

CIRCULATORY SYSTEM

A term used to describe the body’s circulation of blood. The circulatory system is composed of the heart, the arteries, the veins and the lungs. A simplified description of the circulation of blood is as follows: All of the body’s organs require oxygen and nutrients which are delivered by the blood. The body’s blood is circulated and pumped by the heart and the blood is transported in the arteries and veins of the body. The lungs add Oxygen and remove the CO2 from the blood. The circulatory system is a continuous cycle of blood being returned to the heart, the CO2 being removed, Oxygen added and then being pumped out again. The circulation of blood is as follows: The blood, after being "used" by the body’s organs, returns to the right atrium of the heart via the veins of the body. As the "used" blood enters the right atrium, it flows and is pumped into the right ventricle. The right ventricle then pumps the blood to the lungs, where the lungs remove the CO2 and add Oxygen. The newly oxygenated blood then flows to the left atrium, where it is then pumped to the left ventricle. The left ventricle is the real workhorse of the heart, pumping newly oxygenated blood back out to the body’s organs, which then extract the oxygen for their function and discard the CO2 which becomes a by-product of metabolism. The "used" blood is then carried back to the right atrium to start the cycle again.

CONGENITAL

Present at birth. Example: congenital heart disease (heart disease present at birth).

CONGESTIVE HEART FAILURE (CHF)

A condition that is secondary to poor heart function, resulting in a number of physiologic sequelae that are secondary to the "congestion" of blood not being adequately pumped by the heart. Congestive heart failure can be secondary to many causes. Despite the cause, the physiologic consequences are very similar. As noted in the definition of "CIRCULATORY SYSTEM", the heart and lungs are responsible for circulating the blood to and from the body’s organs. When a condition causes "CONGESTIVE HEART FAILURE", it is secondary to the heart’s inability to adequately pump the blood. As a consequence of the blood not being pumped adequately, the blood returning to the heart causes increased pressures in the lungs and the veins of the body. A non-clinical analogy would be a traffic jam on a highway. Because of these increased pressures in the lungs and veins, some of the fluid in the blood can "leak" into the surrounding tissues or lung, making it difficult to breath, or causing an accumulation of fluid in the legs, which is known as edema. Common causes of congestive heart failure are valvular heart disease, such as aortic insufficiency, mitral insufficiency or a significant heart attack.

CONSTRICTIVE PERICARDITIS

A condition in which the pericardium, the fibrous sac that envelops the heart, becomes excessively thick and constricts the heart. This constriction prevents the heart from adequately filling, which leads to inadequate and poor heart function. (See Pericardium, Pericarditis). If the constriction is significant, surgery is performed to remove the thickened pericardium and release the constriction of the heart. This operation is known as a pericardiectomy.

CORONARY

The word "coronary" is used to describe the blood vessels that supply the heart with its blood and oxygen. Most often this refers to the arteries of the heart, but the veins of the heart are also referred to as coronary veins. In general, "coronary" refers to the heart.

CORONARY ARTERY BYPASS GRAFT (CABG)

A section of vein usually from the patient’s leg or an artery from the inside of the patient’s chest that is used to create an alternative pathway for blood to reach the heart muscle. The vein or artery is connected or "grafted" to the diseased coronary artery, thereby creating an alternative pathway for blood to deliver important nutrients and oxygen to the heart muscle.

CORONARY ARTERY BYPASS SURGERY

A surgical operation in which the surgeon uses a section of vein, usually from the patient’s leg or an artery from inside the patient’s chest to create a new route for oxygen-rich blood to reach the heart muscle. The vein or artery used is the bypass graft. One end of the vein or artery is connected to the coronary artery that is blocked or narrowed beyond the blockage or narrowed area. The other end of the vein is connected to the aorta. Usually the other end of the artery is left connected to the main artery from which it branches. By creating this new conduit for blood flow to the heart muscle the graft is said to "bypass" the narrowed or blocked section of the coronary artery in question.

CORONARY ARTERY DISEASE / CORONARY DISEASE

A disease state of the coronary arteries, which is a consequence of a more generalized disease process known as atherosclerosis, commonly referred to as "hardening of the arteries". Coronary artery disease results from a buildup of minerals, fatty deposits and other blood components in the walls of the arteries. As this buildup continues, the lumen, or opening, of the artery becomes progressively smaller and eventually becomes narrow enough to affect the flow of blood through the artery. If the flow of blood is significantly impaired for a long enough period of time the heart muscle can become compromised and a heart attack ensues.

CROSS MATCHING OF BLOOD

The process that a hospital or blood bank goes through to determine if blood that is to be transfused to a patient is compatible with the patient’s blood type. There are numerous combinations of blood types that are compatible with each other, but it is vitally important that any blood that is transfused to a patient has been properly "matched" so that it is compatible to the patient’s blood.

CYANOSIS

A term used to describe the color of a patient’s skin who is not getting enough oxygen. Generally, this condition is more noticeable in people who have light or fair complexions. Cyan is a bluish green color. If the patient’s blood is not being adequately oxygenated and the blood in the tissues is dark red to purple, the skin appears bluish, hence the name cyanosis. Cyanosis is sometimes seen with some congenital heart conditions.

CYST

A fluid-filled sac or mass. The cyst may contain blood, other body fluids, infected fluid (pus) or gases.

CYSTIC FIBROSIS

A chronic disease of the glands of secretion. It may seriously affect respiratory passages, pancreas and liver, and sweat glands.

DECORTICATION

In thoracic surgery, decortication refers to a surgical procedure done to free a fibrous capsule that has formed around the lung, secondary to an inflammatory process, such as an infection. Ordinarily there is a potential space between the lung and the inside of the chest wall, with this space "lubricated" by a thin layer of fluid. In some conditions, such as pneumonia, or after an episode of bleeding in the chest, this space can fill with fluid which can eventually solidify and form a capsule around the lung. As the capsule grows, it can entrap the lung and cause problems with breathing. In a decortication operation, the surgeon works to remove this capsule and free the lung so that it can function normally.

DIAPHRAGM

A dome-shaped muscular fibrous partition that separates the abdominal and thoracic cavities. The diaphraphm contracts and relaxes with respiration and is a significant part of helping a person breathe normally.

DISINFECTION

The process of removing or decreasing the number of micro-organisms from an area or surface. Disinfection is usually done with cleaning the area or surface with a chemical that has known anti-microbial properties.

DISSECTION OF THE AORTA (AORTIC DISSECTION)

A condition of the aorta in which the inner layer of the aorta tears, allowing the blood flowing across the tear to enter the tear and flow between the layers of the aorta. As the blood travels between the layers of the aorta the blood is separating or "dissecting" the layers of the aorta. The aorta is made up of 3 layers. When the inner layer tears, the blood dissects the intima away from the outer two layers. The cause of the intimal tear can be high blood pressure, atherosclerosis, or trauma. Aortic dissections can occur in any portion of the aorta and can become serious or life-threatening. Although they are not true aneurysms, dissections are sometimes referred to as aneurysms or dissecting aneurysms because they can expand and resemble aneurysms of the aorta. Dissections of the ascending aorta and aortic arch are considered surgical emergencies. Dissections of the descending thoracic aorta are often treated medically, but may require surgery depending on certain indications.

DYSPNEA

The medical term for difficult or labored breathing. Dyspnea occurs from a variety of causes such as asthma attacks, acute laryngitis in children, weakness of the heart, and congestive heart failure.

ELECTROCARDIOGRAPH

A machine or device used to record an electrocardiogram, also known as an EKG or ECG. The ECG recorded by the electrocardiograph translates the electrical impulses generated in the heart into wave-like signals that is recorded on paper, and used to diagnose many conditions of the heart. Many heart conditions have characteristic ECG’s that aid the physician in making a diagnosis or directing care.

EMBOLISM

The term used to describe the act of an embolus or emboli moving in the blood stream.

EMBOLUS (plural: EMBOLI)

An embolus is most often a particle or piece of a blood clot, or plaque that has broken loose from a blood vessel wall and is being carried down the vessel by the flow of blood. As the embolus flows down the vessel it is carried into small branches of the blood vessel and can eventually block the flow of blood in the vessel. The lack of blood supply beyond the blockage can cause a variety of problems, depending on what organ the blood vessel is supplying. For example, an embolus to the brain can cause a stroke, while an embolus to the lungs, if large enough, can cause cardiac arrest and can result in death.

EMPHYSEMA

A condition of the lungs, in which the small air sacs of the lungs, know as alveoli expand and dilate secondary to numerous causes. As the alveoli expand the ability to add oxygen and remove CO2 to and from the blood is compromised. Emphysema can be caused by cigarette smoking, inhalation of toxic fumes and some congenital diseases. Emphysema is often grouped with a group of lung diseases referred to as Chronic Obstructive Pulmonary Disease (COPD) Depending on the degree of emphysema, surgery may be performed.

ENDO

A adjective attached to a noun or verb that implies an internal location, such as "endocardium", the inner surface of the heart. When attached to an instrument, such as an "endoscope", it implies that the instrument is used on the inside of an organ or cavity.

ENDOCARDITIS

An infection of a heart valve. The infection is usually secondary to an infection by a bacteria, but can be due to other micro-organisms. Any of the valves can become infected, including valve replacements.

ENDOCARDIUM

The inner surface of the heart muscle. The heart muscle wall is divided into inner and outer surfaces. The inside surface lines the inner chambers of the heart. The outer surface of the heart, where the coronary arteries are located, is known as the epicardial surface of the heart. A heart attack, also known as a "myocardial infarct" that injures the full thickness of the heart is know as an endocardial infarct and is usually more severe than a partial thickness infarct.

ENDOSCOPE

An instrument used to look inside an organ or body cavity. An endoscope is usually composed of 3 components: a) an optic system that allows the physician/surgeon to look through the scope into the organ or cavity, or to attach a video camera to the scope, b) a fiberoptic cable to transmit light into the area, and c) a lumen to take samples of the area being viewed. Generally, the term "endo" is dropped, and the organ or cavity name is associated with "scope" to refer to the use of the instrument. Examples: Bronchoscope refers to an endoscope used to look inside a patient’s lungs. A gastroscope is used to look inside a patient’s stomach.

END-STAGE DISEASE

The very worst condition of an organ or disease state. At this point the organ is barely functioning. Examples: End stage kidney disease means the kidneys have shut down and the patient needs dialysis; End stage heart disease means the heart is functioning very poorly and may need mechanical support or transplantation in order for the patient to survive.

FIBRILLATION

A term used to describe certain irregular heart rhythms, known as arrhythmias.

 

The human heart is divided into the right and left side. Each side of the heart is made up of 1) an atrium and 2) a ventricle. The atrium on each side is a receiving chamber. The right atrium receives the blood from the body after it has been used by the body’s organs. The left atrium receives the newly oxygenated blood from the lungs. The atria pump the blood into their respective ventricles. The right ventricle pumps blood to the lungs, while the left ventricle pumps blood out to the body. The pumping, or contraction, of the atria and ventricles is a coordinated rhythmic motion.

Fibrillation can affect either the atria or the ventricles. With fibrillation the purposeful, coordinated and rhythmic contraction is lost. The fibrillating heart chamber produces uncoordinated movement that does not result in any useful contraction. Atrial fibrillation is not life-threatening, but can cause a decrease in blood pressure, tiredness, and is usually treatable with medication. Sometimes a small shock, known as cardioversion, is used to shock the atria back into a normal rhythm. In severe cases surgery may be performed. Ventricular fibrillation, on the other hand, is a life-threatening arrhythmia, which requires emergency treatment. The treatment for ventricular fibrillation is medication and delivery of a counter shock, known as de-fibrillation. This de-fibrillation is what you see when the soap opera doctors shock a patient in the ER and yell "clear!"

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

The esophagus is the tube that carries the food from the mouth to the stomach. It is separated from the stomach by a muscular sphincter that keeps the acidic contents of the stomach from coming in contact with the lining of the esophagus. "Gastro" refers to the stomach. Gastro-Esophageal Reflux Disease is a condition in which normal mechanisms for keeping the acidic contents of the stomach from coming into contact with the esophageal lining fail, thereby allowing the stomach contents to backwash or "reflux" into the esophagus. The symptoms are those of "heartburn" and can lead to scarring of the lining of the esophagus that can, over time, block the transit of food into the stomach. The scarring can also, in some cases, eventually become cancerous.

HEART

The organ responsible for pumping blood through the lungs and body. The heart is located in the chest cavity behind the breast bone, known as the sternum. The heart is divided into the right and the left side. Each side is composed of an atrium and a ventricle. The right atrium receives the blood from the body after the body’s organs have extracted the needed oxygen. The blood in the right atrium is pumped into the right ventricle, which then pumps the blood to the lungs. In the lung, the CO2 that is in the blood is removed and new oxygen is added. The blood then flows into the left atrium. The left atrium then pumps the newly oxygenated blood to the left ventricle, which then pumps this newly oxygenated blood back out to the body’s organs. The heart is controlled by the autonomic nervous system of the brain that tells the heart to speed up or slow down depending on the body’s needs. The left heart is responsible for the blood pressure measurement you hear at the doctors office. The heart is a tireless pump. If you consider a resting heart rate of 70 beats per minute x 60 minutes per hour x 24 hours a day x 365 days per year, your heart, if you stayed at a resting heart rate of 70 would contract or "pump’ over 36 million times per year!

HEART BLOCK

A condition in which the normal electrical impulses of the heart are interrupted. The interruption causes a change in the normal heart rhythm. The heart muscle normally contracts in a regular, coordinated, rhythmic fashion. These contractions are stimulated and coordinated by tiny electrical impulses from different locations in the heart referred to as "nodes". These electrical impulses from the "nodes" travel down tiny nerve fibers to the heart muscle, helping to stimulate the muscle to contract in a coordinated, synchronized sequence. Different conditions, such as a heart attack, can injure these nerve fibers leading to a blockage of the electrical energy, hence the name "heart block" There are several different types of heart block, which can vary from no symptoms to the heart stopping or beating very slowly and irregularly. The treatment of heart block depends on the type of heart block and its severity. In some instance a pacemaker is necessary to treat heart block.

HEART-LUNG MACHINE

A device used in open heart surgery to support the body during the surgical procedure while the heart is stopped. The heart-lung machine is often referred to as the "pump", and does the work of the heart and lungs during the operation. The heart-lung machine consists of a chamber that receives the blood from the body, which is normally the responsibility of the heart’s right atrium. This blood is then pumped by the machine through an oxygenator, a function normally the responsibility of the right ventricle. The oxygenator removes the CO2 and adds oxygen, which is normally the work of the lungs. The pump then pumps this newly oxygenated blood back to the body, which is normally the work of the left heart. The heart-lung machine is connected to the patient by a series of tubes that the surgical team places. At the end of the operation, the surgeon gradually allows the patient’s heart to resume its normal function, and the heart-lung machine is "weaned off". 

HEART MURMUR

An abnormal sound heard in the heart. A murmur results from blood flowing over or through an irregular surface. Murmurs can be classified in different ways, and different heart conditions have characteristic murmurs or sounds. Not all murmurs are associated with a condition that requires surgery, but a murmur can be used to follow any changes in a heart condition. A non-medical analogy of a heart murmur would be water flowing down a smooth stream. There would be no sound of the flow of water if the stream were perfectly smooth. However, if an irregular surface, such as a stone, is placed in the stream, the water flowing around the irregular surface would cause a sound (a babbling brook). Examples of heart conditions that cause murmurs would be mitral valve prolapse, aortic stenosis, and mitral valve stenosis.

HEMOGLOBIN

A protein consisting of hematin and globin, which gives red blood cells, and therefore blood, its red color. Hemoglobin is the substance in the red blood cell that is responsible for transporting oxygen to the tissues of the body’s organs. Within the organs, the hemoglobin releases the oxygen to the tissues and takes on the carbon dioxide (CO2) from the organ’s tissues. Once the red blood cells with the CO2 is transported to the lungs, the hemoglobin allows the CO2 to exit and takes on a fresh load of oxygen. Different conditions can cause a deficit of hemoglobin, which is referred to as anemia. Part of the hemoglobin complex contains iron. Diets deficient of iron can result in insufficient hemoglobin, which is referred to as "iron deficiency anemia".

HEMORRHAGE

The loss of blood as a result of a injury to a blood vessel. Severe hemorrhage can be life threatening.

HIGH BLOOD PRESSURE

A condition in which the blood pressure generated by the left ventricle and the circulatory system is higher than established norms. High blood pressure can be caused by a variety of heart, circulatory system and other organ diseases. High blood pressure is often without significant symptoms but is a potentially serious problem that can lead to heart attack, stroke, kidney failure and heart failure. High blood pressure is easily detected with a routine physical exam and can be treated through a variety of medications, diet, and exercise.

HYPERHIDROSIS

A condition characterized by excessive sweating of the palms, is also frequently associated with excessive perspiration involving the hands, face, and soles of the feet, as well as the armpits, chest or back.

HYPERTENSION

See High Blood Pressure

HYPOPLASTIC LEFT HEART SYNDROME (HLHS)

A congenital anomaly in which half (left) of the heart is not properly formed. The heart structures usually affected are; the mitral valve, the left ventricle, the aortic valve, and the aorta. Because the left side of the heart is underdeveloped, oxygenated blood cannot be pumped to the body (tissues). This condition is uniformily fatal without surgical intervention. 

INTERSTITIAL LUNG DISEASE

A general term that refers to a variety of chronic lung disorders, characterized by a dry, unproductive cough and uncomfortable breathing on exertion. The condition may result from viral, bacterial, or other infections, uremic pneumonitis, cancer, congenital or inherited disorders, or circulatory impairment. The condition is also known as interstitial pulmonary fibrosis and pulmonary fibrosis.

ISCHEMIA

Lack of oxygenated blood supply to an organ. In heart disease, ischemia is often used to describe the heart muscle that is not getting the proper amount of oxygen-rich blood because of narrowed or blocked coronary arteries. The symptoms of ischemia depend on the organ that is "ischemic". With the heart, ischemia often results in angina or "chest pain" that can be an early warning of an impending heart attack. In the brain, ischemia can result in a stroke.

LAPAROSCOPY

The term used to describe an operation or procedure in which the surgeon uses an instrument called a laparoscope to view the inside of the abdominal (stomach area) cavity, without making the traditional large incision. The laparoscope is an instrument that has a fiberoptic system in the scope, which is introduced into the abdominal cavity via a small (less than a centimeter) incision. The surgeon can then attach a video camera to the scope and view the inside of the abdomen with the scope and camera. By introducing other instruments via similar small incisions, many operations can be done without having to "open" the patient’s abdominal cavity. The advantage to this laparoscopic approach is that the patient recovers more quickly and has potentially less postoperative pain.

LOBECTOMY

The lungs are subdivided into sections referred to as "lobes". The right lung has three lobes, while the left lung has two lobes. A lobectomy is an operation in which the surgeon removes one of "lobes" of the lung. The term "ectomy", when attached to the name of a body part, generally means that body part or a part of the body part is being removed. Lobectomies are done for a variety of surgical diseases, such as cancer, some severe infections, and some benign non-cancerous tumors of the lung.

LOW BLOOD PRESSURE

The term used to describe a condition in which the patient’s blood pressure is lower than acceptable normal limits. "Low Blood Pressure" is also known as "Hypotension".

LUNGS

The organs responsible for adding oxygen to the blood after removing the body’s carbon dioxide (CO2). The lungs are located in the chest and lie on either side of the heart. The lungs are composed of millions of tiny air sacs, known as alveoli. As a person breathes in, the alveoli are filled with fresh air. The heart pumps the blood that has been "used" by the body to the lungs. As the "used" or un-oxygenated blood passes by the alveoli, the CO2 in the blood moves into the alveoli, while the oxygen moves into the blood. The newly oxygenated blood is then transported back to the heart, which pumps out the newly oxygenated blood back out to the body. The air in the alveoli, which is now oxygen depleted, is exhaled out with the exchanged CO2. 

MEDIASTINOSCOPY

An operation in which the surgeon uses an instrument known as a mediastinoscope to examine a portion of the chest cavity known as the "mediastinum". A mediastinoscope is a metal tube that has a lighting system that allows the surgeon to see down the scope into the mediastinum. The mediastinum is subdivided into different sections. The mediastinoscopy procedure is generally done to look into the posterior mediastinum. A mediastinoscopy requires general anesthesia and is done through a small (approx. 1 inch) incision just above the notch in the breast bone. A mediastinoscopy is used to obtain biopsies (pieces) of lymph nodes located in the mediastinum to see if a lung cancer has spread. If the cancer has spread to the lymph nodes, most lung cancers would be considered non-operable.

MEDIASTINUM

The mediastinum is the "middle" section of the chest cavity. The chest cavity contains the left and right lungs, which lie on either side of the heart. The heart is contained in the portion of the chest known as the mediastinum. The mediastinum is bordered by the thoracic inlet (where the organs of the neck enter the chest) on top, by the diaphragm on the bottom, the sternum (breastbone) in front, and the vertebral column (backbone) to the rear. The mediastinum is artificially divided into the anterior, middle and posterior sections. The mediastinum contains all of the chest organs except the lungs. Organs located in the mediastinum include the heart, the aorta, the thymus gland, the chest portion of the trachea, the esophagus, lymph nodes and important nerves.

MINIMALLY INVASIVE HEART SURGERY

A term used to imply surgery done with small incisions or with endoscopic procedures. In heart surgery, minimally invasive surgery may apply to heart operations done without the use of the heart-lung machine, surgery done through small incisions, or robotically assisted operations.

MITRAL VALVE

One of the four (4) valves located in the heart. The mitral valve is made up of two leaflets, chordae tendonae and papillary muscles. The mitral valve is located in the left atrium and left ventricle. All of the valves in the heart are one-way valves, which means that when they are functioning properly, they allow blood to flow in only one direction. The mitral valve allows newly oxygenated blood from the lungs to flow from the left atrium, which receives the blood from the lungs, into the left ventricle. As the left ventricle begins to pump this blood back out to the body, the mitral valve closes, thereby keeping the blood in the left ventricle from flowing back to the lungs. Proper function of the mitral valve is vital to normal, efficient heart function.

MYOCARDITIS

An inflammation of the heart muscle. Causes of "myocarditis" include virus infections, bacterial infections, reactions to some chemotherapy agents, alcohol poisoning from chronic alcohol abuse, and some auto-immune disorders.

MYOCARDIUM

The muscular tissue of the heart.

OCCLUSION / ARTERIAL OCCLUSION

A blockage or a closure of a passageway or vessel. In arterial occlusion, it is the blockage or closure of an artery.

OFF-PUMP SURGERY (BEATING HEART SURGERY)

A coronary artery bypass grafting surgery that is done without the use of the heart-lung machine (known as the "pump"). In off-pump, or beating heart surgery, the patient’s heart is allowed to continue beating while the coronary artery bypass grafts are being placed on the patient’s coronary arteries. This is in contrast to traditional "on-pump" heart operation, which is done with the support of a heart-lung machine. In an on-pump heart surgery, a heart-lung machine does the work of the heart and lungs during the phase of the operation when the heart is being repaired. The heart is normally stopped during these operations. In general, only coronary artery bypass operations are done without heart-lung machine support, while most other heart conditions require heart-lung support in order for the surgery to be performed.

OPEN HEART SURGERY

Most people think that any surgery being done on the heart is "open heart surgery", but technically only heart operations, in which a part of the heart is opened, is called "open heart surgery". All open heart surgeries require the use of the heart-lung machine to support the patient while the heart is being operated upon. Examples of open heart surgeries include valve repair or replacement, closure of congenital defects, repair of ascending aortic dissections and aneurysms, and repair of some complications of heart attack. Coronary artery bypass grafting surgery is technically not an "open heart operation" since only the arteries, which lie on the surface of the heart, are operated on, while the heart cavities are not opened.

PACEMAKER

A small electronic device that is surgically implanted on the chest wall and connected to the heart via small wires. Usually, these wires are placed inside the heart via the large veins that drain into the heart. In some instances, the wires are directly connected to the surface of the heart. The pacemaker’s electronics can sense how often and how regularly the heart is beating. The pacemaker can be programmed to send an electrical impulse to the heart to help it beat faster, more regularly, or both. Pacemakers are necessary for a variety of heart conditions and usually don’t require general anesthesia.

PERICARDIAL WINDOW

A procedure in which an opening is made in the pericardium to drain fluid that has accumulated around the heart. A pericardial window can be made via a small incision below the end of the breastbone (sternum) or via a small incision between the ribs on the left side of the chest.

PERICARDIECTOMY

An operation in which a part or most of the pericardium is removed. A pericardiectomy is usually performed to remove pericardium that has grown too thick and is compressing the heart, not allowing it to function normally. Other indications to remove the pericardium would include infections or tumor growths.

PERICARDITIS

An inflammation or infection of the pericardium. The inflammation can sometimes occur after open heart surgery, and can, in rare cases, lead to constriction of the heart. This type of pericarditis is referred to as post pump pericarditis. Post pump pericarditis can cause some mild chest discomfort and low grade fever. It is diagnosed by clinical symptoms and ECG changes. Post pump pericarditis is treated with anti-inflammatory agents and, in severe cases, with steroids. The cause of post pump pericarditis is not known, but is thought to occur as a consequence of the surgical manipulation of the pericardium and the heart during heart surgery. Other causes of pericarditis include viral and bacterial infections.

PERICARDIUM

The fibrous, normally flexible, sac that envelops the heart. In order to operate on the heart, the pericardium must be opened to expose the heart. Ordinarily there is a small amount of fluid in the pericardium, which is constantly recycled by the body.

PNEUMONECTOMY

A surgical procedure in which an entire lung is removed. A pneumonectomy is most often done for cancer of the lung that cannot be treated by removal of a smaller portion of the lung, which is known as a "lobectomy".

PULMONARY

A term used to refer to the lungs or respiratory system.

RESECTION

Partial or complete surgical removal of a significant part of an organ, tissue, or structure.

RESPIRATORY DISEASES

Diseases that affect the lungs. The lungs are the organs responsible for breathing. Examples of respiratory diseases are infections (pneumonia), tuberculosis, damage to the lungs from cigarette smoking, and lung cancer. Many respiratory diseases are treated with medical therapy, but some may require surgery.

ROSS PROCEDURE

A type of specialized aortic valve surgery where the patient's diseased aortic valve is replaced with his or her own pulmonary valve.

SARCOIDOSIS

A systemic disease of unknown causes. It is characterized by widespread formation of lesions, known as granulomas, in the lungs, liver, spleen, skin, eyes, parotid glands, and the lymph nodes of the mediastinum. It is often associated with a depression of cellular immunity. It is most prevalent in the southern United States. Sarcoidosis is not treatable by surgery, but surgery may be performed to make the diagnosis and to differentiate the sarcoid lesions from other causes such as tuberculosis or fungal infections.

SARCOIDOSIS CORDIS

A form of sarcoidosis in which lesions develop in the myocardium, resulting in cardiac failure in severe cases.

STENT

A device used to treat narrowing or blockage of the coronary arteries. Performed in the cardiac catherization laboratory, the stent is placed by the cardiologist using x-ray guidance. The stent procedure is done with local anesthesia and mild sedation. Coronary stenting is NOT heart surgery. Stenting of the coronary artery is performed for significant narrowing of the artery that causes an impediment of blood flow down the artery. Stenting of the coronary artery is very safe, but there is a small risk to the procedure. Should stenting fail, the cardiologist may refer the patient for coronary artery bypass surgery.

STERNOTOMY

A type of incision in the center of the chest that allows access to the heart.

STRICTURE

An abnormal narrowing of a tubular organ or body part. Strictures can occur as a result of injury, scarring, inflammation, or other disease processes. Examples of strictures are strictures of arteries, strictures of the esophagus, strictures of the airway passages, or strictures of the intestines. Depending on the location and the cause of the stricture, surgery may be performed.

SURVIVAL RATES

Survival rates indicate how many patients or grafts (transplanted organs) are alive/functioning at a set time posttransplant. Survival rates are often given at one, three and five years. Policy modifications are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advances. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates.

TACHYCARDIA

A term used to describe a condition in which the heart is beating at a faster than normal rate. Tachycardia can be due to many causes and is not necessarily a problem. Exercise, stress, excitement, and fear can all cause the heart to beat faster than normal and is a normal response to these factors. There are some heart conditions that can cause tachycardia that is not a normal response to normal daily activity. These tachcardias may be symptomatic and may require treatment. The treatment for most tachycardias is to remove the cause of the tachycardia and medicines to slow the heart rate. Some tachycardias require a procedure or surgery to correct the tachycardia.

THORACOSCOPY

A procedure in which the inside of the chest cavity is viewed or "explored" with a thoracoscope. A thoracoscope is an endoscopic instrument, which is usually composed of either two channels. In a two-channel thoracoscope, one channel is a fiber optic light channel that allows the surgeon to bring light into the chest cavity. The other channel is an optic system that allows the surgeon to look down the scope into the chest cavity, and to introduce instruments that can be used to obtain pieces of abnormal tissue (biopsies). 

THORACOTOMY

A term used to describe the incision used to open the chest cavity. A thoracotomy incision is made between the ribs and is used to perform a variety of lung and some heart operations. 

THROMBOSIS / CORONARY THROMBOSIS

The occlusion or blockage of blood flow within a vessel caused by blood that has clotted within the vessel. Coronary thrombosis is a term used to describe the blockage of a coronary artery secondary to blood clotting within the artery. Thrombosis of coronary arteries occurs when the opening, or lumen, of the artery becomes so small that the blood flow through the narrowed segment slows, allowing the blood to clot in the artery. Thrombosis of a coronary artery can lead to a heart attack if not treated.

TRACHEA

The tube-like structure that allows inhaled air to reach the lungs. The trachea, in non-medical terms, is often referred to as the "wind pipe". The trachea begins immediately below the larynx in the neck and travels into the chest where it divides into two main tubes, known as bronchi. The bronchi are known as the right mainstem bronchus and the left mainstem bronchus.

TRACHEOSTOMY

A procedure in which a small tube is placed into the portion of the trachea that is located in the neck. A tracheostomy is usually done with general anesthesia and is most often performed for patients who will be dependent on a ventilator for a prolonged period of time.

TUBERCULOSIS

A chronic infectious disease caused by the acid-fast tubercle bacillus. Tuberculosis is characterized by the formation of tubercles in the lungs, often developing long after the initial infection. If left untreated, tuberculosis can lead to severe lung damage and possible death. Tuberculosis is generally transmitted by inhaling or ingesting infected droplets from infected patients. Tuberculosis is generally treated with long term antibiotic medications. Surgery used to play a significant role in treating tuberculosis, but with present day medications, surgery is rarely needed.

VAGUS NERVE

Either of the longest pair of cranial nerves that control the pharynx, larynx, lungs, heart, esophagus, stomach, including thoracic and abdominal viscera.

VEINS

Blood vessels that carry blood away from an organ, as opposed to arteries which carry blood toward an organ. Examples of organs are the kidneys, the liver, the brain and the heart. Within the organ, oxygen and nutrients are extracted and carbon dioxide (CO2) is added to the blood. The exceptions are pulmonary veins, which transport newly oxygenated blood from the lungs to the left heart. With this exception, the un-oxygenated blood in the veins eventually flows back to the right side of the heart, which then pumps this blood to the lungs where the CO2 is removed and oxygen is added. The newly oxygenated blood is then transported by the pulmonary veins to the left heart, where it is pumped back out to the body.

VENTRICULAR FIBRILLATION

A condition in which the purposeful, forceful, and rhythmic contraction of the ventricle is lost. Ventricular fibrillation is one of several conditions known as "arrhythmias". With ventricular fibrillation, the heart muscle has no purposeful contractile motion, which results in a loss of the pumping action of the heart. Ventricular fibrillation is fatal if not quickly treated. Ventricular fibrillation can be treated with medications, or through an electrical shock known as a defibrillation.