Maharashtra University of Health Sciences Courses

M.Ch. (Cardio-Vascular Thoracic Surgery)

Course Syllabus

The course of study shall include the theory and applied aspect of:

Anatomy and Embryology: Applied anatomy of

•  heart including cardiac valves , skeleton of heart, muscle arrangement, blood supply, venous drainage, nerve supply, morphology of cardiac chambers and septae ,structure of cardiac muscle
•  aorta, major branches , arteries involved in collateral supply in chest , arteries used as conduits 
• vena cave and their tributaries.
•  trachea ,bronchi and lungs ; pulmonary arteries
•  mediastinum and mediastinal structures
•  thoracic esophagus
•  diaphragm
•  structure and function of a gene
•  rest all the anatomy related to heart, lungs and systemic blood vessels

Physiology:

The Heart :

•  basic physics of membrane potential ,action potential
•  myocardial action potential,
•  energy for contraction of cardiac muscle,
•  cardiac cycle
•  regulation of cardiac function
•  rhythmic excitation of heart,
•  Myocardial metabolism , -- under various conditions( full /empty beating, fibrillating, cold, arrested state
•  skeletal & smooth muscle contraction , difference from the myocardium

Circulation :

•  Physics of blood , blood flow and pressure
•  Physical characteristics of the systemic circulation and function of large and small arteries
• arterioles, capillaries and veins.
•  control of blood flow to individual organs ( brain, heart, kidneys)
•  arterial pressure control : rapid and long term control
•  cardiac out put , venous return & their regulation
•  Pulmonary circulation
• coronary circulation
•  cardiac failure and circulatory shock

Respiration:

• Mechanism of pulmonary ventilation, pulmonary volumes and capacity functions of respiratory passageways
•  physical principle of gas exchange & diffusion of O2 & CO2.
• transport of O2 & CO2 in blood.
•  regulation of respiration
•  Body fluids , Kidneys and Acid base balance
•  Metabolism

CNS :

• brain waves,
• thoracic autonomic system
•  Basic characteristics of sympathetic and parasympathetic function

Hypothermia :

•  Core temperature and surface temperature, Insulator system of body, heat transfer from body core , heat production and loss, regulation of body temperature , isotherms and oikilotherms Effect on metabolic rate, heart, circulation, blood viscosity, ions, hormone release, solubility of blood gases, pH changes, SVR/PVR

Bacteriology, Virology, Parasitology & immunology :

•  Streptococci , Staphylococci, Common gram negative bacteria
•  Mycobacteria
•  Aspergillosis and fungi affecting heart and cardiac valves.
•  immunology relevant to heart and lung transplantation
•  life cycle of Echinococcus
•  HIV virus

Pathology:

 General pathology required to understand specific pathology: degeneration, infarction, necrosis, stunning, hibernation  gross and microscopic pathology of

• rheumatic heart disease
• syphilitic heart disease
• tuberculous heart disease
• atherosclerotic cardio vascular disease
• cardiac myxoma
• suppurative lung diseases
• hydatid disease of lung
• pulmonary tuberculosis
• benign tumors of lung
• carcinoma of lung
• Medistinal tumors and Thymic hyperplasia and Thymomas.
• CHD: ( including the anomalies and variants associated with) ASD, VSD, AV canal, PDA, AP window, RASOV,TOF, Pulmonary atresia , TAPVC, Tric.atresia, Single Ventricle physiologies, Transposition complexes, Truncus arteriosus Ebstein’s anomaly, Pulmonary stenosis , aortic stenosis, coarctation of aorta,
• HIV related infections
• Burger’s disease
• specific and non specific aorto arteritis  gross and microscopic features of
  • valvular heart diseases not covered above
  • cardiomyopathies
  • benign and malignant diseases of pleura
  • benign and malignant tracheal tumors
  • benign and malignant tumors of esophagus
  • cardiac tumors other than myxoma
  • CHD : not covered in the above list

Pharmacology:

 antibiotics , antitubercular , antifungal and antiviral drugs  Pharmacology of drugs used in the treatment of

• congestive cardiac failur
• hypertension
• angina pectoris
• eripheral vascular disease
• acidbase imbalance
• supra ventricular and ventricular arrrhythemia
• motherapy of carcinoma lung

 Pharmacology of drugs used as

• oral and parenteral anti coagulants, antiplatelet agents, fibrinolytic agents, and their antidotes.
• bronchodilators , mucolytics
• systemic and pulmonary vasodilators conduit dilators for bypass grafts vasoconstrictors
• diuretics
• Others :
  • adenosine , antifibrinolytics, serine protease inhibitors,
  • constituents of cardioplegia , Free radical Oxygen Scavengers
  • immunosuppresants used in heart lung trans plant
  • drugs used in pre-anesthetic medication and anesthesia

Cardio – Thoracic Surgery

• Function of the gas Exchange System and its Evaluation
• Anesthesia for CardioThoracic surgery.
• Postoperative Care and complications in CardioThoracic surgery .
• Ventilatory assistance and support. Respiratory support in infants
• shock : types, diagnosis ,management. Cardio pulmonary resuscitation.
• Use of Antibiotics in Cardiac and Thoracic Surgery
• Computer Application in Cardio thoracic Surgery.
• Thoracic Incisions, complications of incision including sternal dehiscence
• Thoracic trauma.
•  Pulmonary resection Anatomy and Techniques.
• Thoracic Imaging.
• Esophagoscopy
•  Bronchoscopy: trans bronchial biopsy and bronchoalveolar lavage.
• Thoracoscopy : general principles, diagnostic & therapeutic procedures
• Developmental Abnormalities of the airways and lungs
• sequestration of lung,
• Surgical treatment of the Bullous Emphysema.
• Diagnosis of Benign, diffuse Pulmonary Disease.
• Pneumonia, Bronchiectasis, and lung abscess.
• Thoracic infections caused by Actinomycetes, Fungi, Opportunistic organisms, and Echinococcus.
• Surgical treatment of tuberculosis
• Molecular biology and immunology of lung and esophageal cancer.
• Benign tumors of the lower respiratory tract.
• Lung carcinoma :diagnosis, staging, surgery for- ,limited pulmonary resection, bronchoplastic techniques for
• Multimodality Therapy of Carcinoma of the Lung: Irradiation, Chemotherapy, and Immunotherapy.
• Indications for Resection of Pulmonary Metastases.
• Thoracic disorders in an immunocompromised host
• Pulmonary embolism acute & chronic
• Pulmonary AV fistule
• Lung Transplantation.
• Benign & Malignant Disorders of Pleura
• Pleural Space Problems & Thoracoplasty
• Thoracic Outlet Syndrome
• Chest wall & sternal abnormalities & management of chest wall tumours
• Diaphragm : developmental, traumatic, neoplastic disorders, dysfunction & pacing
• Mediastinal tumours, Thymic tumors and managemnt of myesthenia gravis
• Trachea : tumors , strictures , tracheomalacia ,tracheal resections & reconstructions .
• The Esophagus : Anatomy & Functional Evaluation .
• Esophageal injuries
• Medical & Surgical Treatment of Hiatal Hernia .
• Barrette’s Esophagus.
• Nissen Fundoplication .
• Hill Procedure .
• Belsey Mark IV Procedure.
• Benign Strictures of Esophagus .
• Paraoesophageal Hiatal Hernia.
• Esophageal Dysmotility.
• Treatment of Achalasia & Gastroesophagial Reflux.
• Thoracoscopic Esophageal Surgery .
• Carcinoma of Esophagus, surgical options Resection, Reconstruction, Palliative treatment of Carcinoma of the Esophagus .
• special diagnostic and therapeutic procedures in cardiac surgery:
• Echocardiography, Cardiac catheterization, angiography and interventional techniques ,
• PTCA & stenting , Fibrinolytic therapy in the management of acute myocardial infarction, Role of CT scan, MRI , radionuleotide imaging in Cardiovascular Diagnosis.
• Normal & Abnormal Development of the Heart.
• Peri operative care of the pediatric cardiac patient.
• Anesthesia for Pediatric Cardiac Surgery.
• Management of Cardiopulmonary Bypass in adults,infants & children .Pump, oxygenators, fiters, tubings, cannule, ultrafiltration for CPB
• Deep Hypothermia & Total Circulatory Arrest.
• Myocardial Protection & cardioplegia: rational of various constituents, common cardioplegic solutions. Constitution of cardioplegia used at the candidates institute.
• Palliative Procedures in Congenital Heart Disease
• Tracheoesophageal Compressive Syndromes of Vascular Origin: Rings & Slings.
• Anomalous Pulmonary and Systemic Venous Connections.
• Atrial Septal Defects and Cor Triatriatum.
• Ventricular Septal Defect.
• Patent Ductus Arteriosus and Aortopulmonary Window.
• Atrioventricular Septal Defects.
• Tetrology of Fallot and related physiological complexes
• Complex of Functional Single Ventricle.
• Truncus Arteriosus.
• Congenital Malformations of the Aortic Valve and LVoutflow tract.
• Coarctation of Aorta and Interrupted Aortic Arch.
• Hypoplastic Left Heart Syndrome.
• Pulmonary Stenosis with intact IVS
• Pulmonary Atresia with intact IVS
• Transposition of Great Arteries
• Congenitally Corrected Transposition of the Great Arteries.
• Double Outlet Right Ventricle and Double Outlet Left Ventricle.
• Tricuspid Atresia.
• Ebstein’s Anomaly
• Congenital Abnormalities of the Mitral Valve.
• Heart & heart – lung transplantation in children
• Circulatory Support in Infants and Children
• Anomalies of the Coronary Vessels
• Hemorrhagic and Thrombotic Complications of Cardiac Surgery.
• Intra-aortic Balloon Counter pulsation,Ventricular Assist Pumping,
• Artificial Heart.
• Preservation of Intrathoracic Organs for Transplantation.
• Heart & heart-lung Transplantation.
• Cardiomyoplasty, surgical treatment for congestive cardiomyopathies.
• Surgery for Bacterial Endocarditis.
• Acquired Disease of the Tricuspid Valve.
• Acquired Disease of the Mitral Valve.
• Acquired Aortic Valve Disease
• Surgical management of Hypertrophic Cardiomyopathies
• Homografts and Auto grafts
• Cardiac Valvular Prostheses: design, selection, complications of
• Coronary Revascularization: non surgical techniques, surgical indications, direct and indirect surgical interventions, conduit selection &harvesting , surgical management of complications of MI, combined Coronary and carotid artery disease.
• Surgery for supraventricular & ventricular Arrhythmias.pacemaker therapy.
• Aneurysms of the ascending , arch and descending thoracic aorta
• Dissections of the Aorta.
• Constrictive pericarditis, cardiac tamponade
• Other diseases of pericardium.
• Cardiac myxoma
• Cardiac Tumors.
• History of
  • a) heart , lung and vascular surgery ( out line)
  • b) prosthetic valves
  • c) Cardiopulmonary Bypass & cardioplegia
  • d) ASD closure
  • e) coronary surgery
  • f) Cardiovascular & Thoracic (CVT) surgery in India , Mumbai and at the candidate’s institution
• legends in CVT surgery
• Prosthetic material ( biological / artificial) in Cardio, vascular and thoracic surgery
• Sutures in CVT Surgery: physical properties of sutures, needle types, recent advances in suture materials.

Vascular

• Physiologic assessment of peripheral arterial occlusive disease
• vascular imaging techniques
• Burger’s disease
• Takayasu’s disease , Nonspecific aortoarteritis
• management of arterial aneurysms
• fibrodysplasia
• uncommon arteriopathy
• antithrombotic therapy
• angioplasties and endovascular techniques
• basic vascular surgical technique, Fogarty thrombectomy, endarterectomy
• Vascular grafts
• Complications of vascular surgery and interventions
• management of acute ischemia of limbs
• management of chronic ischemia of limbs and viscera
• management of thoracic outlet syndrome
• other neurovascular conditions involving the upper extremity
• congenital vascular malformations
• management of renovascular hypertension
• management of extracranial cerebrovascular disease
• management of deep venous thrombosis