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1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 SABISTON & SPENCER SURGERY OF THE CHEST  ISBN: 978-1-4160-5225-8 Copyright © 2010, 2005, 1995, 1990, 1983, 1976, 1969, 1962 by Saunders, an imprint of Elsevier Inc. 1962 copyright renewed 1990 by John H. Gibbon, Jr. All rights reserved. All rights reserved.  No part of this publication may be reproduced or transmitted in any form or by any means,  electronic or mechanical, including photocopying, recording, or any information storage and retrieval system,  without permission in writing from the publisher. Details on how to seek permission, further information about the  Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center  and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher  (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden  our understanding, changes in research methods, professional practices, or medical treatment may become  necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and  using any information, methods, compounds, or experiments described herein. In using such information or  methods they should be mindful of their own safety and the safety of others, including parties for whom they  have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most  current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be  administered, to verify the recommended dose or formula, the method and duration of administration, and  contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of  their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,  and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any  liability for any injury and/or damage to persons or property as a matter of products liability, negligence or  otherwise, or from any use of operation of any methods, products, instructions, or ideas contained in the  material herein. The Publisher Library of Congress Cataloging-in-Publication Data Sabiston & Spencer surgery of the chest. – 8th ed. / editor- in-chief, Frank W. Sellke; editors, Pedro J. del Nido,   Scott J. Swanson. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4160-5225-8 1.  Chest–Surgery. 2. Heart–Surgery. I. Sabiston, David C., II. Sellke, Frank W. III. Del Nido, Pedro J.   IV. Swanson, Scott J. V. Title: Surgery of the chest. VI. Title: Sabiston and Spencer surgery of the chest.   [DNLM: 1. Thoracic Surgical Procedures—methods. WF 980 S116 2010] RD536.S236 2010 617.5’ 4059—dc22   2009003431 Acquisitions Editor: Judith Fletcher Developmental Editor: Lisa Barnes Publishing Services Manager: Tina Rebane Senior Project Manager: Linda Lewis Grigg Printed in USA Last digit is the print number:  9  8  7  6  5  4  3  2  1 To my wife, Amy, who gives me love, inspiration, and unwavering support and to our children, Michelle, Eric, Nicholas, and Amanda. They provide us with unlimited pleasure. FWS To Martha, Alexander, Sara, Daniel, and Elizabeth. Thank you. PJD To my wife, Donna, and our children, Kate, Whit, and Maggie, who make this all worthwhile. SJS Contributors Brian G. Abbott, MD, FACC, FASNC Nasser K. Altorki, MD Assistant Professor of Medicine (Clinical) Professor of Cardiothoracic Surgery The Warren Alpert Medical School of Brown University Weill Cornell Medical College Division of Cardiology, Rhode Island Hospital Chief, Division of Thoracic Surgery Medical Director, Nuclear Cardiology NewYork–Presbyterian Hospital Rhode Island Cardiology Center New York, New York Providence, Rhode Island Screening for Lung Cancer Nuclear Cardiology and Positron Emission Tomography in the Assessment of Patients with Cardiovascular Disease Robert H. Anderson, BSc, MD, FRC Path Emeritus Professor  David H. Adams, MD Institute of Child Health  Marie-Josée and Henry R. Kravis Professor and Chairman University College  Department of Cardiothoracic Surgery London, United Kingdom Mount Sinai School of Medicine Visiting Professor  Program Director, Mitral Valve Repair Reference Center Division of Pediatric Cardiology Mount Sinai Medical Center Medical University of South Carolina New York, New York Charleston, South Carolina Acquired Disease of the Mitral Valve; Ischemic Mitral Visiting Professor Regurgitation Institute of Human Genetics Newcastle University Lishan Aklog, MD Newcastle Upon Tyne, United Kingdom Chair Cardiovascular Center/Chief of Cardiovascular  Surgical Anatomy of the Heart Surgery Heart and Lung Institute Masaki Anraku, MD, MSc St. Joseph’s Hospital and Medical Center Fellow, Division of Thoracic Surgery Phoenix, Arizona Toronto General Hospital/University of Toronto Faculty of  Ischemic Mitral Regurgitation Medicine Toronto, Ontario Arvind K. Agnihotri, MD Canada Assistant Professor of Surgery Lung Cancer: Surgical Treatment Harvard Medical School Massachusetts General Hospital Anelechi C. Anyanwu, MD Boston, Massachusetts Associate Professor Postinfarction Ventricular Septal Defect Department of Cardiothoracic Surgery Director, Heart and Heart-Lung Transplantation Louise A. Aquila Allen, PhD Department of Cardiothoracic Surgery Manager, Training and Clinical Support Mount Sinai School of Medicine Syncardia Systems, Inc. New York, New York Tucson, Arizona Ischemic Mitral Regurgitation Total Artificial Heart Simon K. Ashiku, MD Mark S. Allen, MD Department of Surgery Chair, Division of General Thoracic Surgery Walnut Creek Medical Center Department of Surgery Walnut Creek, California Mayo Clinic Tracheal Lesions Rochester, Minnesota Chest Wall Tumors v v Contributors Erle H. Austin III, MD Hendrick B. Barner, MD Professor of Surgery Adjunct Professor of Surgery Division of Thoracic and Cardiovascular Surgery Department of Surgery University of Louisville School of Medicine Saint Louis University School of Medicine Chief, Congenital Cardiothoracic Surgery Clinical Professor of Surgery Kosair Children’s Hospital Department of Surgery Louisville, Kentucky Washington University in St. Louis School of Medicine Pulmonary Atresia with Intact Ventricular Septum Thoracic Surgeon Saint Louis University Hospital Eric H. Awtry, MD, FACC St. Louis, Missouri Assistant Professor of Medicine Bypass Conduit Options Department of Medicine Boston University School of Medicine David J. Barron, MD Inpatient Clinical Director Consultant Cardiac Surgeon Division of Cardiology Birmingham Children’s Hospital Boston Medical Center NHS Foundation Trust Boston, Massachussettes Birmingham The Pharmacologic Management of Heart Failure United Kingdom Surgery for Congenitally Corrected Transposition of the Great Emile A. Bacha, MD, FACS Arteries Associate Professor of Surgery Harvard Medical School Joseph E. Bavaria, MD Senior Associate in Cardiac Surgery Professor of Surgery Children’s Hospital Boston University of Pennsylvania School of Medicine Boston, Massachusetts Staff Surgeon and Vice Chief, Division of Cardiothoracic  Congenital Tracheal Disease; Ventricular Septal Defect and Surgery Double-Outlet Right Ventricle; Adult Congenital Cardiac Hospital of the University of Pennsylvania Surgery; Image-Guided and Hybrid Surgery: Surgical Philadelphia, Pennsylvania Simulation Endovascular Therapy for Thoracic Aortic Aneurysms and Dissections Richard Baillott, MD, FRCSC Department of Surgery David P. Bichell, MD Institut Universitaire de Cardiologie et de Pneumologie de  Professor of Cardiac Surgery Quebec Vanderbilt University School of Medicine Laval University Faculty of Medicine Chief, Pediatric Cardiac Surgery Department of Cardiac Surgery Monroe Carell Jr. Children’s Hospital at Vanderbilt Hôpital Laval Nashville, Tennessee Quebec City, Quebec Atrial Septal Defect and Cor Triatriatum Canada Deep Sternal Wound Infection Edward L. Bove, MD Professor of Surgery Donald S. Baim, MD University of Michigan Medical School Executive VP, Chief Medical and Scientific Officer Thoracic Surgeon Boston Scientific Corporation University of Michigan Health Systems Natick, Massachusetts Ann Arbor, Michigan Nonatherosclerotic Coronary Heart Disease Truncus Arteriosus and Aortopulmonary Window Leora B. Balsam, MD William J. Brawn, MD Assistant Professor Consultant Cardiac Surgeon  Department of Cardiothoracic Surgery Birmingham Children’s Hospital New York University School of Medicine NHS Foundation Trust New York, New York Birmingham Heart Transplantation United Kingdom Surgery for Congenitally Corrected Transposition of the Great Arteries Contributors x Christian P. Brizard, MD Robert M. Califf, MD Associate Professor Vice Chancellor, Duke University The University of Melbourne Faculty of Medicine, Dentistry  Professor of Medicine and Health Sciences School of Medicine Duke University School of Medicine Cardiac Surgery Unit Director, Duke Translational Medicine Institute Royal Children’s Hospital Melbourne Durham, North Carolina Melbourne, Victoria Medical Management of Acute Coronary Syndromes Australia Congenital Anomalies of the Mitral Valve Edward Cantu III, MD Cardiothoracic Fellow Julie A. Brothers, MD Department of Surgery Assistant Professor Duke University Medical Center Department of Pediatrics Durham, North Carolina University of Pennsylvania School of Medicine Critical Care for the Adult Cardiac Patient Attending, Department of Cardiology The Children’s Hospital of Philadelphia Justine M. Carr, MD Philadelphia, Pennsylvania Assistant Professor Surgery for Congenital Anomalies of the Coronary Arteries Departments of Surgery and Medicine Harvard Medical School Morgan L. Brown, MD, PhD Senior Director Resident Department of Clinical Resource Management Department of Anesthesiology and Pain Medicine Beth Israel Deaconess Medical Center University of Alberta Boston, Massachusetts Edmonton, Alberta, Canada Clinical Quality and Safety in Cardiac Surgery Ebstein’s Anomaly Joseph P. Carrozza, Jr., MD Ayesha S. Bryant, MSPH, MD Chief, Cardiovascular Division Assistant Professor Caritas St. Elizabeth’s Medical Center Department of Surgery, Division of Cardiothoracic   Vice President, Caritas Cardiovascular Network Surgery Boston, Massachusetts University of Alabama at Birmingham School of Medicine Interventional Cardiology Birmingham, Alabama Benign Lesions of the Lung Frank Cecchin, MD Associate Professor of Pediatrics Harold M. Burkhart, MD Department of Pediatrics Associate Professor  Harvard Medical School Department of Surgery, Division of Cardiovascular   Senior Associate in Cardiology Surgery Children’s Hospital Boston Mayo Clinic Boston, Massachusetts Rochester, Minnesota Arrhythmia and Pacemaker Surgery in Congenital Heart Disease Congenital Lung Diseases Robert J. Cerfolio, MD Christopher A. Caldarone, MD Professor  Professor and Chair, Division of Cardiac Surgery Department of Cardiothoracic Surgery Department of Surgery University of Alabama at Birmingham School of Medicine University of Toronto Faculty of Medicine Chief, Section of Thoracic Surgery Staff Surgeon UAB Hospital Division of Cardiovascular Surgery Birmingham, Alabama The Hospital for Sick Children Benign Lesions of the Lung Toronto,  Ontario Canada Surgical Considerations in Pulmonary Vein Anomalies x Contributors Riya S. Chacko, MD Joanna Chikwe, MD, FRCS (CTh) Cardiology Fellow Department of Cardiothoracic Surgery Department of Cardiology Mount Sinai School of Medicine Harvard University Associate Program Director Cardiology Clinical Fellow Department of Cardiothoracic Surgery Department of Cardiology New York, New York Beth Israel Deaconess Medical Center Acquired Disease of the Mitral Valve Boston, Massachusetts Interventional Cardiology W. Randolph Chitwood, Jr., MD Eddie and Jo Allison Smith Distinguished Chair Professor Alfred Chahine, MD, FACS, FAAP Department of Cardiovascular Sciences Associate Professor of Surgery and Pediatrics Senior Associate Vice Chancellor for Health Sciences The George Washington University School of Medicine East Carolina University Brody School of Medicine Attending Surgeon Director, East Carolina Heart Institute at Pitt County  Department of Pediatric Surgery Memorial Hospital Children’s National Medical Center Greenville, North Carolina Program Director Robotic Cardiac Surgery and Novel Visualization Systems Department of General Surgery Residency Georgetown University Medical Center Karla G. Christian, MD Washington, District of Columbia Associate Professor Surgery for Congenital Lesions of the Esophagus Department of Cardiac Surgery Vanderbilt University Vincent Chan, MD Associate Chief Chief Resident Department of Pediatric Cardiac Surgery Department of Cardiac Surgery Monroe Carell, Jr. Children’s Hospital at Vanderbilt University of Ottawa Heart Institute Nashville, Tennesee Ottawa, Ontario, Canada Atrial Septal Defect and Cor Triatriatum Coronary Artery Bypass Grafting Neil A. Christie, MD Frederick Y. Chen, MD, PhD Assistant Professor of Surgery Assistant Professor of Surgery University of Pittsburgh School of Medicine Division of Cardiac Surgery Director, LIFE Bronchoscopy Program Harvard Medical School Heart, Lung and Esophageal Surgery Institute Associate Surgeon Division of Thoracic and Foregut Surgery Division of Cardiac Surgery Member, Division of Thoracic Surgery Brigham and Women’s Hospital University of Pittsburgh Medical Center Boston, Massachusetts Pittsburgh, Pennsylvania Management of Native Valve Endocarditis Innovative Therapy and Technology Alvin J. Chin, MD Joseph C. Cleveland, Jr., MD Professor Associate Professor of Surgery Department of Pediatrics Division of Cardiothoracic Surgery University of Pennsylvania School of Medicine Department of Surgery Senior Physician University of Colorado Denver Division of Cardiology Surgical Director, Adult Cardiac Transplantation/Mechanical  Department of Pediatrics Circulatory Devices Children’s Hospital of Philadelphia Department of Surgery, Division of Cardiothoracic Surgery Philadelphia, Pennsylvania University of Colorado Hospital Interrupted Aortic Arch Aurora, Colorado Chief, Cardiothoracic Surgical Services Cynthia S. Chin, MD Division of Cardiothoracic Surgery Assistant Professor of Surgery Department of Surgery Division of Cardiothoracic Surgery Veteran’s Administration Medical Center Mount Sinai School of Medicine Denver, Colorado Thoracic Surgeon Thrombosis and Thromboembolism of Prosthetic Cardiac Mount Sinai Medical Center Valves and Extracardiac Prostheses New York, New York Anatomy of the Thorax; Esophageal Resection and Replacement Contributors x Lawrence H. Cohn, MD Jack G. Copeland, MD Virginia and James Hubbard Professor of Cardiac Surgery Jack G. Copeland, MD, Endowed Chair of Cardiothoracic  Department of Surgery Surgery Harvard Medical School Professor of Surgery Surgeon University of Arizona College of Medicine Division of Cardiac Surgery Chief, Section of Cardiothoracic Surgery Brigham and Women’s Hospital Staff Surgeon Boston, Massachusetts University Medical Center Management of Native Valve Endocarditis Tucson, Arizona Total Artificial Heart William E. Cohn, MD Associate Professor of Surgery Scott W. Cowan, MD Baylor College of Medicine Assistant Professor of Surgery Director Department of Surgery Minimally Invasive Surgical Technology University of Pennsylvania Texas Heart Institute Assistant Professor of Surgery Adjunct Professor Department of Surgery Department of Bioengineering Penn Presbyterian Medical Center University of Houston Philadelphia, Pennsylvania Houston, Texas Secondary Lung Tumors Alternative Approaches to Coronary Artery Bypass Grafting Melissa Culligan, RN, BSN Yolanda L. Colson, MD, PhD Thoracic Surgery Clinical Nurse Associate Professor of Surgery Department of Thoracic Surgery Harvard Medical School Penn Presbyterian Medical Center Surgeon Philadelphia, Pennsylvania Department of Thoracic Surgery Secondary Lung Tumors Brigham and Women’s Hospital Boston, Massachusetts François Dagenais, MD, FRCSC Interstitial Lung Diseases Department of Surgery Institut Universitaire de Cardiologie et de Pneumologie de  Wilson S. Colucci, MD, FACC, FAHA Quebec Thomas J. Ryan Professor of Medicine Laval University Faculty of Medicine Department of Medicine Department of Cardiac Surgery Boston University School of Medicine Hôpital Laval Chief, Section of Cardiovascular Medicine Quebec City, Quebec Boston University Medical Center Canada Boston, Massachusetts Deep Sternal Wound Infection The Pharmacologic Management of Heart Failure Ralph J. Damiano, Jr., MD Andrew C. Cook, PhD John M. Shoneberg Professor of Surgery Senior Lecturer Vice Chairman Cardiac Unit Department of Surgery UCL Institute of Child Health Washington University in St. Louis School of Medicine Great Ormond Street Hospital Chief of Cardiac Surgery NHS Foundation Trust Barnes-Jewish Hospital London, United Kingdom St. Louis, Missouri Surgical Anatomy of the Heart Surgical Treatment of Arrhythmias Joel D. Cooper, MD Thomas A. D’Amico, MD Professor of Surgery Professor of Surgery University of Pennsylvania School of Medicine Duke University School of Medicine  Chief, Department of Surgery Section Chief and Program Director, General Thoracic Surgery University of Pennsylvania Health System Duke University Medical Center Philadelphia, Pennsylvania Director, Clinical Oncology Surgery for Emphysema Duke Comprehensive Cancer Center Durham, North Carolina  Lung Cancer: Minimally Invasive Approaches x Contributors Jonathan C. Daniel, MD Pedro J. del Nido, MD Department of Surgery  William E. Ladd Professor of Child Surgery  University of Arizona Harvard Medical School Thoracic Surgeon Chief, Department of Cardiac Surgery  University Medical Center/Tucson Medical Center Children’s Hospital Boston Tucson, Arizona Boston, Massachusetts  Surgery of the Diaphragm: A Deductive Approach Surgical Approaches and Cardiopulmonary Bypass in Pediatric Cardiac Surgery; Atrioventricular Canal Defects; Transposition Philippe G. Dartevelle, MD of the Great Arteries: Simple and Complex Forms; Image- Guided and Hybrid Surgery: Surgical Simulation Professor Department of Thoracic and Cardiovascular Surgery Tom R. DeMeester, MD Paris Sud University Le Kremlin–Bicêtre Professor and Chair, Department of Surgery Head, Department of Thoracic and Vascular Surgery and  USC Keck School of Medicine Heart-Lung Transplantation Los Angeles, California Esophageal Anatomy and Function Marie Lannelongue Hospital Le Plessis Robinson Philippe Demers, MD Paris France Assistant Professor of Surgery Anterior Approach to Superior Sulcus Lesions University of Montreal Cardiovascular Surgeon Tirone E. David, MD, FRCSC, FACS Montreal Heart Institute and Sacre-Coeur Hospital Professor Montreal, Canada Type A Aortic Dissection; Type B Aortic Dissection University of Toronto Faculty of Medicine Head, Division of Cardiovascular Surgery Todd L. Demmy, MD Melanie Munk Chair of Cardiovascular Surgery Toronto General Hospital Associate Professor of Surgery and Clinical Scholar Toronto, Ontario Department of Surgery Canada Associate Professor of Oncology Surgery of the Aortic Root and Ascending Aorta State University of New York University of Buffalo School of  Medicine and Biomedical Sciences Jonathan D’Cunha, MD, PhD Chairman, Department of Thoracic Surgery Assistant Professor Roswell Park Cancer Institute Department of Surgery Buffalo, New York Malignant Pleural and Pericardial Effusions University of Minnesota Medical School Staff Surgeon Eric J. Devaney, MD University of Minnesota Medical Center Fairview Health Services Assistant Professor Minneapolis, Minnesota Department of Surgery The Use of Genetic Science in Thoracic Disease University of Michigan Medical School Cardiothoracic Surgeon Joseph A. Dearani, MD Cardiovascular Center/University of Michigan Health  Professor of Surgery Systems Mayo Medical School College of Medicine Ann Arbor, Michigan Truncus Arteriosus and Aortopulmonary Window Division of Cardiovascular Surgery Mayo Clinic Elisabeth U. Dexter, MD, FACS Rochester, Minnesota Ebstein’s Anomaly Assistant Professor of Surgery Department of Surgery, Section of General Thoracic Surgery Daniel T. DeArmond, MD State University of New York Upstate Medical University  Assistant Professor  College of Medicine Department of Surgery Thoracic Surgeon Division of Cardiothoracic Surgery Syracuse VA Medical Center University of Texas Health Science Center at San Antonio  Syracuse, New York Perioperative Care of the Thoracic Surgical Patient School of Medicine San Antonio, Texas Congenital Lung Diseases Contributors x Marisa Di Donato, MD Sitaram M. Emani, MD Department of Cardiac Surgery Instructor in Surgery IRCCS Istituto Policlinico San Donato Department of Cardiac Surgery Milan Harvard Medical School Associate Professor in Cardiology Assistant in Cardiac Surgery University of Florence Faculty of Medicine and Surgery Department of Cardiac Surgery Florence, Italy   Children’s Hospital Boston Left Ventricular Restoration: Surgical Treatment of the Failing Boston, Massachusetts Heart Patent Ductus Arteriosus, Coarctation of the Aorta, and Vascular Rings; Pulmonary Atresia with Ventricular Septal Christopher T. Ducko, MD Defect and Right Ventricle–to–Pulmonary Artery Conduits Department of Surgery Harvard Medical School Jeremy J. Erasmus, MD Associate Surgeon Professor Department of Surgery Department of Diagnostic Radiology, Division of Diagnostic  Brigham and Woman’s Hospital Imaging Boston, Massachusetts The University of Texas M.D. Anderson Cancer Center Surgeon Houston, Texas Department of Surgery Radiologic Imaging of Thoracic Abnormalities Carney Hospital Dorchester, Massachusetts Dario O. Fauza, MD Surgeon Associate Professor Department of Surgery Department of Surgery South Shore Hospital Harvard Medical School Wymouth, Massachusetts Associate Pleural Tumors Department of Surgery Children’s Hospital Boston Brian W. Duncan, MD Boston, Massachusetts Medical Director Congenital Diaphragmatic Hernia Cleveland Clinic Cleveland, Ohio Felix G. Fernandez, MD Tetralogy of Fallot with Pulmonary Stenosis Assistant Professor Department of Thoracic Surgery Carlos M. G. Duran, MD, PhD Emory University School of Medicine Chair of Cardiovascular Sciences Atlanta, Georgia University of Montana College of Health Professions and  Lung Transplantation Biomedical Sciences Chairman of the Board Hiran C. Fernando, MD International Heart Institute of Montana Foundation Associate Professor of Cardiothoracic Surgery Missoula, Montana Boston University School of Medicine Surgical Treatment of the Tricuspid Valve Director of Minimally Invasive Cardiothoracic Surgery Boston Medical Center Fred H. Edwards, MD Boston, Massachusetts  Medical Director Endoscopic Therapies for Thoracic Diseases; Innovative Department of Cardiothoracic Surgery Therapy and Technology University of Florida Farzan Filsoufi, MD Jacksonville, Florida Quality Improvement and Risk Stratification for Congenital Associate Professor Cardiac Surgery Mount Sinai Medical Center Associate Chief Cardiac Surgery Department of Cardiothoracic Surgery Mount Sinai Medical Center New York, New York Acquired Diseases of the Mitral Valve

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Through seven successful editions, Sabiston & Spencer Surgery of the Chest has set the standard in cardiothoracic surgery references. Now, the new 8th Edition, edited by Frank W. Sellke, MD, Pedro J. del Nido, MD, and Scott J. Swanson, MD, carries on this tradition with updated coverage of today's e
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