JohHnosp kTienxst book ofC ardiotShuorrgaecric y Notice Mediicasinn e ev er-cshicaenngAcisnen e.grw e seaanrcdcl hi neixcpaelr i­ encber oaoduekrnn owlcehdagneig,nte rse atamneddnr tut gh eraarpey requThiera eudt.h aonrtdsh p eu bliosfth hewiros r hka vceh ecwkietdh sourbceelsit eobv ere edl iiantb hleeeiff rot ropt rso viindfeo rmtahitasit o n compalnegdte en eirnaa clclwoyir ttdhh s et andaacrcdeasptt t hetedi moef publiHcoawteiivovennir .,eo wtf h peo bsislioihftu ym aenr roorr chiann ges medisccaile nneciettshh,aee ur t hnootrrhs p eu blnisoahrne oyrt hpearr ty whoh as beeni nti hnpevr oelpvaeordrap t uibolnio cfta htwiiosor wnka r­ rantthsta htie n formcaotnitoani neiids ne hveerrreeysi panec cctuo rra te complaenttdhe de,iy scallralei smp onsibeirlriootrry s o fmoiorsr s ainoyn s frot hree soublttasfi rnouemsdo e ft hien formcaotnitoainint n hweiodsr k. Readaerreesn c outroac goendfit rhmie n formcaotnitoahnie nrewedii tnh othseoru rFcoeersx .a mapnlidenp artircaeudleaarrrase,d vitsoce hde ck thper odiuncfto rmsahteiienotcn l iuntd hepeda ckoafeg aecd hr utgh ey plana dtmoi ntiobs ect eerrtt hataihtnie n formcaotnitoainint n hweiodsr k iasc ctuear natdh cahta nhgaevnseo b te emna dient he recodmomseen ded or tihcneo ntrainfdoairdc maitniiosnTtshr riaestc ioomnm.e nidosaf t ion partiicmuploarirtnc a onncnee wcittniheoo wnri nfrequuesnedtdrl u.yg s SecoEnddi tion Edited By DavDi.Yd u hM,D ,F ACFCA,C S StepCh.Ye ann,M D g Professor and Chief, Section of Cardiac Surgery The Arthur B. and Patricia B. Modell Professor in Thoracic Surgery Department of Surgery Division of Thoracic Surgery Yale University School of Medicine Department of Surgery New Haven, Connecticut Johns Hopkins University School of Medicine Surgical Director Baltimore, Maryland Yale-New Haven Hospital Heart and Vascular Center JohnD otMyD, R. New Haven, Connecticut Adjunct Professor of Surgery Former Associate Professor of Surgery, Division of Cardiothoracic Surgery Division of Cardiac Surgery Intermountain Heart Institute at Intermountain Medical Center Department of Surgery University of Utah Johns Hopkins University School of Medicine Salt Lake City, Utah and The Johns Hopkins Hospital Baltimore, Maryland LucAa.V ricMeDll,Fa A,C S Associate Professor of Surgery and Pediatrics Director, Pediatric Cardiac Surgery and Heart Transplantation Johns Hopkins University School of Medicine Baltimore, Maryland Medical I NewY orCkh icaSgaFon r ancAitshceoLn osn doMna drid MexiCciotM yi laNne wD elhSii ngaSpyodrneTe oyr onto Copyright© byM cGraw-HiEldlu catiAolnlr. i ghrtess ervEexdc.e patsp ermitutnedde trh eU niteSdt atCeosp yrigAhctto f nop arotf t his 2014, 2007 1976, publicamtaiyob ne r eproduocred di stribuitnae ndy f ormo rb ya nym eanso,rs torienda d atabaosrre e triesvyaslt ewmi,t hotuhtep riowrr ittpeenr missoifo n thep ublisher. ISBN: 978-0-07-171493-8 MHID: 0-07-171493-6 Them aterial eBooakl saop pears pr of tthiitsTl SeB:N : in this in the int version 978-0-07-166350-2, MHID: 0-07-166350-9. eBookc onversbiyoc no deMantra Version 1.0 All trademararkes tr ademarokfst heriers pectoiwvnee rRsa.t hetrh apnu ta tr ademarsky mboalft eerv eroyc curreonfca e tr ademarkneadm ew,e usen ameins ane ditorfiaaslh ioonnl ya,n dt ot heb enefiotft hetr ademaorwkn erw,i tnho i ntentoifio nnfr ingemoefnt th etr ademarWkh.e res ucdhe signataipopnesai rnt his bookt,h ehya veb eenp rintweidt ihn itciaapls . McGraw-HEidlulc atieoBno okasr ea vailaabtsl pee ciqaula ntdiitsyc outnotu ss ea sp remiumasn ds alepsr omotioornf so ru sein corportraatien ipnrgo grams. Toc ontaacr te presentpalteiasvveei ,s tihteC ontaUcstp agea tw ww.mhprofessional.com. TERMSO F USE Thiiss a copyrighwtoerdka ndM cGraw-HiEldlu catiaonndi tlsi censroersse ravlerl i ghitnsa ndt ot hew orkU.s eo ft hiwso rki ss ubjetcott hestee rms. Excepatsp ermitutnedde trh eC opyrigAhctto f andt her ighttos toraen dr etrioenveec opyo ft hew orky,o um ayn otd ecompidlies,a ssemrbelvee,r se 1976 enginereerp,r odumcoed,i fyc,r eadteer ivawtoirvkebs a seudp ontr,a nsmidti,s tribduitses,e minsaetlepl,u, b liosrsh u blicetnhsewe o rko ra nyp arotf i tw ithout McGraw-HEidlulc atiopnr'isoc ro nseYnotu.m ayu set hew orkf oyro uorw nn oncommercainadpl e rsonuaslea ;n yo theurs eo ft hew orki ss tricptrloyh ibited. Yourr ighttou set hew orkm ayb et erminaitfye odu f aitloc omplwyi tthh estee rms. THE WORK ISP ROVIDED" ASI S.M"c GRAW-HILELD UCATIONAN D ITSL ICENSORMAKES NO GUARANTEESO R WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESSO F OR RESULTST O BE OBTAINED FROM USINGHIE WORK, INCLUDING INFORMA­ ANY TIONT HATC AN BE ACCESSEDT HROUGH TI-IE WORK HYPERLINK OR OTHERWISEAN,D EXPRESSLY DISCLAIM WARRANTY, VIA ANY EXPRESS OR IMPLIED, INCLUDINBGU TN OT IMITEDT OI MPLIEDW ARR ANTIESO F OR FITNESFSO R A PARTICULAR MERCHANTABILITY PURPOSEM.c Graw-HiEldlu catiaonndi tlsi censdoorn so tw arraonrtg uaranttheaett h ef uncticoonnst aiinnet dh ew orkw ilmle ety ourr equiremoern ts thaitt osp eratwiiolnbl e u ninterrourpe trerdofr re eN.e ithMecrG raw-HEidlulc atinoonri tlsi censsohrasbl lel iabtloye o uo ra nyoneel sfeo ra nyi naccuracy, erroorro missiroeng,a rdloefcs asu sien,t hew orko rf oarn yd amagerse sulttihnegr efroMmc.G raw-HEidlulc atihoansn or esponsibfioltri htecy o nteonfat n y informaatcicoen sstehdr outghhew orkU.n denro c ircumstasnhcaeMlscl G raw-HEidlulc atiaonnd /iotrls i censboer sl iafboalrn ey i ndirienccti,d enstpaelc,i al, puniticvoen,s equenotrsi iamli ldaarm agetsh arte sufrlotm theus eo fo ri nabitloiu tsyet hew orke,v einf a nyo ft hemh asb eeand visoefdt hep ossibiolfsi utcyh damageTsh.i lsi mitaotfil oina bislhiatlaylp pltyoa nyc laiomr c ausweh atsoewvheert hseurc chl aiomr c ausaer isiensc ontratcotro,tr o therwise. To wmifye D,r.B onnHiiea ftotar,c cepmtymi anngfly a ws anidd inocsryaasnifdeo gsri vmienm gym oscth erigsifthse,d NataalniCdeh ristYoopeuha ecr.h mmyal kifweeo rltihv ing. -DavDi.Yd u MhD,F, A CFCA,C S To wmifyeS imofnoatr,he en dlseascsro ififlc iev ing twenytaeyrw si tash u rg.e.ao.nn fd o brr ighteevneirnyg day ofm yl ifwei thhep rr eselnocavenep,d a rrtsnheip. -LucVar iAc.Me DlF,lA aC,S Tom ym entsotrusd,er netssid,ae nncdto sl,l eagues-from whoIm' lveea rsnoe dm Auncdhf .ot rh ree taela cihnle ifres- my pareMnutrsia enlHd a ryYr anmgy,w ifMea riavnicdcih ,l dren KrisAtnidnay,n, Ad l ex. -StepCh.Ye annM gD, Tom ym entaotGr eso rgeUtnoiwvne ThresJ iothy,Hn osp kins HospiatnIadnl t,e rmoMuendtiaCcieannl tf eotrrh epiart ience andde dictaomt yis ounr geidcuacla atnitdoo mn y,w ifaen d famfioltryh ekiirn dneusnsd earnsdt daunrditinhnjgigo s u rney. -JoRh.Dn o tMyD, Thpiasg ien tentlieboftln aanlkl y G CONTENTS Contrixbiu tors Lunga ndH eart-LuTnrga nsplanta1t5i7o n ll. Forewxoxridi i AshiSs.Sh h ah Prefxxav ce 12.E sophagPehayls iolFougnyc,t iToens ts, andE ndoscopTiecc hniqu1e6s9 A GENERATLHO RACICS URGEYR 1 DanieJload orkoJvoshkyn,C laraknedK, e rrBy.D unbar 0. ..._,. 1.P reoperaEtviavleu atoifot nh e 13.C ongeniEtsaolp hagAenaolm alie1s8 3 Thoracic Surgical3 Patient NishaDn.Pt a taenlAd v edMiesn eshian KelKl.yN agasaawnadJ ohRn. D oty 14.G astroesophRaegfelauDlxi seaasned 2.Th oraciTcr auma9 Esophageal Motility1 D9i1s orders Georf.g Keo enJir.ga ndD avidE fron ShelBlayn sBarli,a Gno odmaannd,E dmunSd.K assis T. 3.P ulmonaPrhyy siolFougnyc,t iToens tasn,d 15.E sophagPeearlf orati2o0n5 BronchoscToepcihcn iqu2e5s ClintD.oK ne mpa ndS tephCe.Yn a ng LonnYya rmuasn dD avif. dF eller-nK opma 16.E sophagCeaanlc er2 15 4.C ongeniPtuallm onaDriys order4s1 JulLeisna ndM arBk. O rringer AnneC .F iscahnedrE riGcrif fiths 17.M ediastiDniasle as2e2 9 5.B enigDni ffusPeu lmonaDriys order4s9 LePel antmaNsaotna,Ll uiiea, n dP ierThreeo dore ChrisAt.iM aenr lo 18.C hest Tumors2 43 Wall 6.Th oraciIcn fectio6n3s RobeAr.tM eguiadn dM alcolBmr ock V. KaushiMka nda/ 19.C ongeniCthaels t Anomalie2s6 7 Wall 7.S urgical ManaogfeE mmepnhty sema8 9 IbrahSiuml taanndS tepheYna ng C. AleGx. L ittle 20.B enigPnl eurDails order2s8 9 8.T racheDails ease9s7 JoshuTaa ylaonrd MauAr.Si mciet h T. Dan RazT,o dSd.W eisaenr,dD ouglf. aMsa thisen f. 21.B enigann dM alignaPnlte urTaulm ors3 01 9.P rimarLyu ngC ancer1 19 SivRaa jCaa,r olF arvSeurd,i Cs.hM urthy, F. Min Kima ndA raA .V aporciyan andD aviMda son P. 10.P ulmonaMreyt astas1i4s5 22.D iaphragmaDtiisco rder3s0 9 DuyKhanChe ppaan dB ettyT ong JarrDo.Pd r ediannadS unSiiln ghal P. C. vii viii Contents 39.A scendianngdA rchA neurysomfst heA orta5 91 A ADULTC ARDAICS URGEYR 321 AnthoDn.yC affarePlileitJ,,eA r.v and eSrt arre, andR .S coMtitt chell 23.C ardiovascFuulnacrt iaonnd P hysiolo3g2y3 JeffreMy. D odd-o 40.Th oracoabdomiAnnaelu rysm6s2 5 YinWge iL uma ndG lenSn.R oseborough 24.C ardiopulmoBnyaprays s3 41 EdwarHd.K incaainddJ ohn Hammon 41.A ortiDci ssecti6o4n7 W ThoraMlf .S undt III 25.M yocardPiraolt ecti3o5n9 ConstanLt.Ai tnhea nasualnedGa esr aDl.dB uckberg 42.E ndovascuRleapra iorfTh oracic AortiPca tholog6y6 3 26.P ostoperative Manoaftg heeCm aerndti ac Timotfh.Gye oragnedJ ameHs.B laIcIkI SurgicPaalt ien3t7 1 RashGnian walNlaau,d Fearr adaany,dG lenWhni tman 43.S urgicTahle rapifoerAs t riFailb rillat6i8o1n TimWoe imaarn dR alphD amiaJnro. f. 27.P rimarCyo ronaArryt erByy pasSsu rger3y8 7 G.D.R ushianngdD aviDd.Y uh 44.P acemakaenrd D efibrillaThteorra py inC ardiSaucr gery Pat6i9e5n ts 28.O ff-PumpC oronaArryt erByy pass4 07 BraSd.S uttKoenn,n etBhi lchaincdRk o,n aDl.dB erger C. EriAc.P ecakn dP auSle rgeant 45.S urgicTarle atmeonfCt h roniPcu lmonary 29.R eoperatCiovreo naArryt erByy pasSsu rger4y2 1 ThromboembolDiics eas7e1 5 Christf.o Bpahrerre Gieroor,fg A.er naoutaankdJi asGy,. S hake MichaMe.Ml a danain dS tuaWr Jta mieson 30.M anagemeonftC oncomitCanatr otid 46.R oloef S urgeirnyM anagemeonftH ypertrophic andC oronaArryt erDyi seas4e3 1 Cardiomyopat7h3y1 Danif.e Dlu ranSdv,a Stiin gLloan g,a ndD aviDd.Y uh HartzVe Slclh aff 31.M echanical ComploifcM aytoicoanrsd ial 47.P ericarDdiisaela s7e4 1 Infarcti4o3n9 Erif. cO kuma ndA beD eAndJra. RyaRn. D aviMeisc,h aeRlo bicahn,dM ichaAe.Cl o ady P 48.P rimarCya rdiTaucm ors7 53 32.A ortViacl vRee placeme5n0t1 BrianB ethaenadA damR ichter T. WilliMa.Ym a rbroaungdJh o hSn.I konomidis 49.Th e ImmunobioloofgThyoracic 33.A ortiRco otR eplaceme5n2t5 Transplanta7t6i9o n KaushiMka ndaain dD ukEe. C ameron Marc HalushaknadW illiMa.Bm a ldwin K. III 34.M itrVaall vPea thophysiol5o3g9y 50.C ardiTarca nsplanta7t8i3o n TomaAs.zT imeakn dJ amesF ann KennetLhi aaon dS arf.a S humway I. K. 35.M itrVaall vRee placeme5n5t1 51.M echanicCailr culatSourpyp ort7 97 StepheHnu ddlesatnodDn a viDd.Y uh ClintDo.Kn e mpa ndJ ohnC onte f. V 36.M itrVala lvRee paifro rD egeneratDiivsee as5e6 1 52.S urgicVaeln tricuRleamro delin8g3 5 GurjyBoatj wTao,m isMliahva ijeavnidAc .,M arGci llinov ClintDo.K ne mpa ndJ ohnC onte V 37.T ricusVpaildv Dei seas5e7 1 53.S temC ellfso rC ardiSaucr gicDails eas8e4 9 DaviLd.Jo yce PeterJ ohnsatnodGn a rGye rstenblith V 38.S urgical TreoafEt nmdeoncta rdi5t8i1s 54.M inimalIlnyv asiCvaer diSaucr ger8y6 1 JohRn. D otayn dW illiaCma ine D.K alavrouaznidFo rtainsc ois Dagenais T. Contents ix 55.C ardiCaact heterizaantdIi notne rventi8o7n3s 70.P ulmonary StaenndoP suilsm onary Atwrietshi a TodAd. D orfmaanndJ onR .R esar IntaVcetn tricuSleaprt um1 095 CarLa.L awrenDceeb,o rf.a Kho ziakn,dM arDk. P lunkett 56.E chocardiogirnaCp ahryd iSaucr ger8y9 3 CollHeaernr ingStaomniM,ao raa,n dK atherCi.Wn ue 71.D oublOeu tleRti ghVte ntric1l1e1 3 JesThso mpsoann dJ oseAp.Dh e arani 57.C ardiMaacg netic ResoInmaangcien g9 21 fenVso gel-ClaanudDs asveinAd .B luemke 72.T runcuAsr terios1u12s7 TarKaa ramlDo.uM ,i chael McaMnudlG loarndA,o. nC ohen � CONGENAILTC ARDIAC 73.T otal Anomalous PuVlemnoonuasr y SURGEYR 941 Connectio1n1 41 ErgKionc yildainrdVi imc toMro rell 0. 58.M ilestoinneC so ngeniCtaarld iSaucr ger9y4 3 74 .T ransposiotfti hoenG reaAtr terie1s14 7 LucAa. V riceVlilnac,Le .nG to tatn,dD ukEe. C ameron RichaGr.Od h yeM,i ng-SSiiJn,eg n nifCe.Hr i rsch-Romano, 59.Th e Anatomoyf C ongeniCtaarld iac ZuhaAb.Q amar,a ndE dwaLrd.B ove Malformatio9n5s5 75.C ongenitCaolrlrye ctTerda nsposit1i1o6n1 RobeHr.tA ndersaonndA ndreCw.C ook EmiAl.eB acha 60.P erioperaCtriivteiC caarleo ft he 76.H ypoplasLteiftHc e arSty ndrome1 171 PediatCraircd iSaucr gicPaalt ien9t7 3 PeteGrr ubaenrd Th omasL .S pray StacBi.Pe e ddMya,r iAs.sB ar uneatntdJi am,i Mec Elrath Schwartf. z 77.T ricusAptirde sainad t heF unctionSailnlgyl e 61.C ardiopulmoBnyaprays isnt he Ventric1l1e8 3 PediatPraitci en9t8 3 CariAn.v anD oorVni,c toTrs anagn,dM arRc. d eL eval JacoObs trowasnkdRy o sUsn gerleider T. 78.S urgefroyrL eftV entricOuultarfl ow Tract 62.P alliaOtpievrea tifoonrs ObstructiinCo hni ldre1n1 93 CongeniHteala rDti seas9e9 1 TarKaa ramlou, PLeersmtuetr, RMiacrccio, TarKaa ramlaonudG ordAo.nC ohen C. andG ordAo.nC ohen 63.P atenDtu ctuAsr terios1u0s0 1 79.C oarctatoifto hneA ortaan d Tain-HYseinJa e,ffr eyW u,a ndR ichaRridn gel f. InterrupAtoerdtA irc ch 1215 MarkD. R odefeld 64.A triSaelp tal DeafnedPc atrst iAanlo malous PulmonaVreyn ouCso nnectio1n0 09 80.C orT riatriat1u2m3 3 DariTor oiRsiec,h aRridn gaenldF, r ancePsacoolA non ecchino GiancaCrrluop i 65.V entricuSleaprtD aelf ect1s0 29 81.V alvulDairs eains eC hildre1n2 43 DaviLd. SM.o ralBersa,n Bd.Si c ulalnydC, h arlD.eF sr asJer.r ChristiBarni zaarnddY veds' Udekdef\.mc oz P. 66.A trioventrSiecuptlaDaler f ect1s0 43 82.C ardiSaucr gicIanlt ervenitniP oend iatPraitci ents MazyKaanra nia ndM artiEnl liott f. witCho nnectTiivses uDei sorder1s2 67 GiorZgainoo tDtuik,Ee . C ameroann,dL ucAa. V ricella 67.A ortopulmonaryWin1d0o6w3 VictoMro realnldE rgKionc yildirim 0. 83.S urgefroyrC ongeniCtoarlo naArryt ery Anomalie1s2 77 68.T etraloofgF ya llo1t0 69 JulAi.Be r othaenrds W illiGaamy nor OsamHio njaon dG leSn.V anA rsdell f. 84.V asculRairn gasn dP ulmonaArryt erSyl ing1 295 69.P ulmonaArtyr eswiiat Vhe ntricSuelpartD aelf ect CarLle wiBsa ckMeir,c haCe.Ml o ngaen,dH ydMe. R ussell andM ajoAro rtopulmonary Col1l0a8t5e rals Malcof.l Mma cDonaalnddF ranLk.H anley