Cardiothoracic is a medical term that describes the organs and structures located within the chest, also known as the thorax. It is most commonly associated with the surgical specialty of cardiothoracic surgery. This field focuses on the operative treatment of conditions affecting the heart, the lungs, and the major blood vessels connected to these organs. The complex nature of the chest cavity requires a high level of specialized training, making this a demanding surgical discipline.
Anatomical Focus: The Thoracic Cavity
The thoracic cavity is the space within the upper trunk, defined as the area extending from the base of the neck down to the diaphragm. This bony cage is formed by the ribs, the sternum (breastbone), and the thoracic spine, creating a protective enclosure for vital organs. The primary structures central to cardiothoracic care include the lungs and the heart, located within their respective pleural and pericardial sacs.
The space between the lungs is known as the mediastinum, which houses several other important structures. This central area contains the esophagus, the trachea (windpipe) and its main bronchi, and the thymus gland. The great vessels—the main arteries and veins connected to the heart—also run through this cavity, including the aorta, the pulmonary artery, the superior vena cava, and the pulmonary veins.
The Two Major Disciplines
Cardiothoracic surgery is functionally divided into two distinct, highly integrated subspecialties to manage the broad range of chest conditions. These disciplines are Cardiac Surgery and General Thoracic Surgery, each requiring specialized knowledge and technical skills. This differentiation allows surgeons to focus their expertise on either the circulatory system or the respiratory and digestive systems within the thorax.
Cardiac Surgery concentrates exclusively on the heart and the great vessels immediately attached to it. The goal is to correct structural defects, restore proper blood flow, and repair or replace damaged cardiac components. Surgeons in this field possess deep knowledge of cardiopulmonary bypass, a technique that temporarily takes over the function of the heart and lungs during open-heart operations.
General Thoracic Surgery focuses on all other organs and structures within the chest cavity, excluding the heart itself. This includes the lungs, the esophagus, the trachea, the chest wall, and the mediastinum. The expertise required often centers on treating benign and malignant diseases, such as cancers affecting the lungs or the lining of the chest.
Core Procedures and Conditions Treated
Cardiothoracic surgeons treat a wide array of life-threatening and complex conditions using specialized operative techniques. In Cardiac Surgery, a common procedure is Coronary Artery Bypass Grafting (CABG), which reroutes blood flow around blocked coronary arteries using a healthy vessel. Surgeons also perform valve repair or replacement to treat conditions like aortic stenosis or mitral regurgitation, where the heart’s valves do not open or close correctly.
Advanced Cardiac procedures involve operations for heart failure, such as implanting mechanical devices like a Left Ventricular Assist Device (LVAD) to help the heart pump blood. For end-stage heart disease, cardiac surgeons perform heart transplantation, replacing a diseased heart with a healthy donor organ. They also treat congenital heart defects, correcting structural problems present from birth, such as holes between the heart chambers.
Procedures in General Thoracic Surgery frequently center on treating cancers affecting the lungs and esophagus. For lung cancer, surgeons perform a lobectomy (removal of an entire lobe) or a pneumonectomy (removal of the entire lung). These resections are often performed using minimally invasive techniques, such as Video-Assisted Thoracoscopic Surgery (VATS), which utilizes small incisions and a camera.
Esophageal surgery constitutes a large part of the thoracic surgeon’s practice, treating conditions ranging from severe acid reflux to esophageal cancer. Procedures can involve removing parts of the esophagus or repairing a hiatal hernia, where the stomach pushes up through the diaphragm. Thoracic surgeons also manage severe chest trauma and remove tumors located in the mediastinum, such as those arising from the thymus gland.