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Table of Contents

Magill’s Medical Guide, 9th Edition

Thoracic surgery

by Chanel Rutledge, , MS-III

Category: Specialty

Anatomy or system affected: Chest, heart, lungs, respiratory system

Specialties and related fields: Cardiology, general surgery, pulmonary medicine

Definition: The branch of surgery that treats diseases of the chest cavity, especially the heart.

Key terms:

aneurysm: a weakened segment of the heart or blood vessel

balloon catheterization: the use of a balloon-like device on the tip of a catheter to widen blood vessels

cardiac catheterization: the guidance of a catheter into the heart or great blood vessels to measure function, assess problems, and identify solutions

computed tomography (CT) scanning: the use of X-ray computer technology to identify diseases of hard and soft tissues, such as bone and the heart

echocardiography: the use of sound waves to examine heart structures

mitral valve: the valve between the heart’s left auricle and left ventricle

stenosis: the narrowing of heart valves or blood vessels

SCIENCE AND PROFESSION

The chest, or thorax, lies between the neck and the abdomen, from which it is separated by the diaphragm. The side boundaries of the chest are the ribs and the muscle which surrounds it, which are attached to the spine and breastbone (sternum) in the back and front of the body, respectively. Overall, the thorax is cone-shaped, with its small and large ends bounded by the neck and diaphragm. Inside this airtight cavity, the lungs are suspended on the right and left sides, covered by the membranous pleura. Between the lungs is the heart, with its covering, the pericardium.

Also located in the chest cavity are the trachea (windpipe), which leads to the lungs; the esophagus, which connects the mouth and stomach; the major blood vessels that enter and leave the heart; and nerves. The chest cavity inflates and deflates due to diaphragm and rib muscle movement. This action provides the entry of oxygen to the blood that is circulated around the body through the cardiovascular system.

Thoracic surgeons, sometimes called “cardiothoracic/cardiovascular and thoracic surgeons,” handle a wide variety of surgery associated with these organs. Preeminent in many cases is surgery of the heart and major blood vessels. This precise, exacting surgery requires residency training of six years in general surgery and three years in thoracic surgery. In the United States, thoracic surgeons are certified by the American Board of Surgery and the American Board of Thoracic Surgery. Much of the time of thoracic surgeons is spent in hospitals working with critically ill patients whose lives depend on the prompt use of specialized and demanding surgical techniques. Most patients undergoing thoracic surgery are aged fifty-five to sixty-five.

DIAGNOSTIC AND TREATMENT TECHNIQUES

The diagnostic techniques associated with thoracic surgery are highly refined. They include careful patient histories, laboratory tests, and noninvasive techniques such as echocardiography, computed tomography (CT) scanning, electrocardiography (ECG or EKG) and other types of electrophysiology. Invasive procedures include cardiac catheterization and cineangiography of the heart and surrounding blood vessels with fiber-optic devices. Hence, cardiothoracic surgeons require extensive technical backup and wide expertise. Surgery is carried out after quick and careful assessment of all information is obtained. Thoracic surgeons are noted for great surgical dexterity, scientific expertise, and logical, stepwise development of a complete picture that enables them to arrive rapidly at sensible decisions before and during surgery.

All thoracic surgeries require a thoracotomy, which is a surgical procedure that allows entry into the chest cavity. Patients are given a general anesthetic and concurrently have heart and lung function replaced by a heart-lung machine, which oxygenates the blood and pumps it through the cardiovascular system.

Anterior thoracotomy is used to gain access to the heart and its coronary arteries. First, a vertical incision is made from between the collarbone to the lower end of the sternum, to which the ribs are attached. The sternum is divided with a bone saw and pried apart to expose the surgical area. After surgery, a drain is inserted into the chest, the sternum is wired together, and the muscle and skin are closed.

Lateral thoracotomy uses curved incisions made from between the shoulder blades and around the side of the trunk to just below a nipple. It provides access to the lungs and the great blood vessels. This technique is used by thoracic surgeons, general surgeons, and other specialists who perform lung surgery. After the incision is complete, the ribs are spread apart and surgery is performed. Closure is the same as with the anterior procedure. Recently, minimally invasive thoracic surgery has been done more often to reduce the need for an open thoracotomy. With this type of surgery, multiple small incisions are made instead of fully opening the chest cavity. A thoracoscope is attached to a video camera, which allows visualization of the chest.

Many different thoracic surgery procedures are carried out on the heart and great blood vessels when medical and dietary treatments fail or in cases of congenital and traumatic problems. They can be divided into valve replacement, artery surgery, and heart transplantation. Bypass surgery was a major aspect of cardiothoracic surgery at some point. Today, it has been largely replaced by balloon catheterization and related techniques carried out by other specialists.

Three types of important cardiothoracic surgery are heart valve replacement, aneurysm resection, and heart transplantation. Heart valve replacement may be necessitated by severe mitral valve damage, which causes mitral insufficiency or stenosis that can lead to heart failure and death. Aneurysms are weakened portions of the heart or great blood vessels. Heart aneurysms are caused by myocardial infarction (the death of parts of the heart muscle), yielding areas of weak, noncontractile scar tissue. Vessel aneurysms are caused by atherosclerosis or infectious disease. In extreme cases, aneurysms can rupture, and they are always painful and/or life-threatening. They are repaired by resection and replacement with graft materials such as Dacron or Teflon appliances. In the most severe cardiac problems, whole heart transplantation is needed using cadaver hearts. When this is not possible, and the heart must be aided, ventricular assist pumps and artificial hearts can be connected temporarily.

PERSPECTIVE AND PROSPECTS

Thoracic surgery was first successful in the United States in the early twentieth century. The development of the New York Thoracic Surgical Society in 1917 marked the beginning of the acceptance of thoracic surgery as a medical specialty. In the 1930s, the Journal of Thoracic Surgery started to describe the area, and treatment methods evolved rapidly. Much impetus came from thoracic injuries that occurred during World War II. By the late 1940s, a Board of Thoracic Surgery was affiliated with the American Board of Surgery. In 1971, it became the independent American Board of Thoracic Surgery, which certifies thoracic surgeons. There are several thousand board-certified thoracic surgeons.

Some firsts in this field were the relief of mitral stenosis, by Elliott Cutler (1923); surgical intervention for cardiac aneurysm, by Ernst Sauerbruch (1931); the successful ligation of an arterial duct, by Robert Gross (1939); the development of a heart-lung machine for humans, by John Gibbon (1954); and the relief of congenital pulmonary defects, by Alfred Blalock (1954).

In current thoracic surgery, the treatment of coronary artery disease, once restricted to surgical bypass, has largely been replaced by techniques performed by cardiologists. Nevertheless, thoracic surgical procedures continue to improve, and the development of ever-better diagnostic tools and appliances is expected, such as a satisfactory artificial heart.

See also: Aneurysmectomy; Aneurysms; Bypass surgery; Cardiac surgery; Cardiology; Cardiology, pediatric; Chest; Congenital heart disease; Heart; Heart disease; Heart transplantation; Heart valve replacement; Lung surgery; Lungs; Mitral valve prolapse; Pulmonary medicine; Pulmonary medicine, pediatric.

For Further Information:

1 

Crawford, Michael, editor. Current Diagnosis and Treatment—Cardiology. 5th ed., McGraw-Hill Medical, 2017.

2 

Doherty, Gerard M., and Lawrence W. Way, editors. Current Surgical Diagnosis and Treatment. 15th ed., Lange Medical Books/McGraw-Hill, 2020.

3 

Eagle, Kim A., and Ragavendra R. Baliga, editors. Practical Cardiology: Evaluation and Treatment of Common Cardiovascular Disorders. 3rd ed., Lippincott Williams & Wilkins, 2020.

4 

Gersh, Bernard J., editor. The Mayo Clinic Heart Book. 2nd ed., William Morrow, 2000.

5 

“Heart Surgery Overview.” Texas Heart Institute, Aug. 2012.

6 

“Lung Surgery.” MedlinePlus, 4 June 2012.

7 

Pearson, F. Griffith, et al., editors. Thoracic Surgery. 3rd ed., Churchill Livingstone, 2008.

8 

Porter, Robert S., et al., editors. The Merck Manual of Diagnosis and Therapy. 20th ed., Merck Research Laboratories, 2006.

9 

Taylor, Anita D. How to Choose a Medical Specialty. 6th ed., Elsevier, 2017.

10 

“What Is a Heart Transplant?” National Heart, Lung, and Blood Institute, 3 Jan. 2012.

Citation Types

Type
Format
MLA 9th
Rutledge, Chanel. "Thoracic Surgery." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1351.
APA 7th
Rutledge, C. (2022). Thoracic surgery. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Rutledge, Chanel. "Thoracic Surgery." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.