M.Ch (Cardio Thoracic Surgery)

M.Ch (Cardio Thoracic Surgery)

COURSE OF STUDY
The course of study shall include:
i) A wide coverage of Basic Sciences like Anatomy, Physiology, Biochemistry, Pathology,
Microbiology, Pharmacology and Immunology pertaining to the Cardiovascular and Respiratory
systems and the Chest and its contents;
ii) a thorough knowledge , theoretical as well as practical, of the various investigative procedures
- invasive and non-invasive - including biochemical, radiological and ultrasonographic
investigations, radioisotope scanning and dynamic function studies such as pulmonary function
tests, cardiac catheterisation and oesophageal manometry;
iii) a detailed knowledge of and practical experience in clinical and operative paediatric and adult
cardiac surgery, surgery of great vessels and peripheral arteries and general thoracic surgery
including surgery of the chest wall, diaphragm, oesophagus, mediastinum, trachea , lungs and
pleura ; and
iv) a broad knowledge or Cardiology, Respiratory Medicine and other medical problems relating
to Cardiovascular-thoracic Surgery , as well as of Computer application.
The course of study shall include the theory and applied aspect of:
1] 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
2] 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
3] 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
4] Pathology:
*** General pathology required to understand specific pathology:
degeneration, infarction, necrosis, stunning, hibernation
*** gross and microscopic pathology of
1) rheumatic heart disease
2) syphilitic heart disease
3) tuberculous heart disease
4) atherosclerotic cardio vascular disease
5) cardiac myxoma
6) suppurative lung diseases
7) hydatid disease of lung
8) pulmonary tuberculosis
9) benign tumors of lung
10)carcinoma of lung
11) Medistinal tumors and Thymic hyperplasia and Thymomas.
12)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,
13)HIV related infections
14)Burger's disease
15) specific and non specific aorto arteritis
** gross and microscopic features of
1) valvular heart diseases not covered above
2) cardiomyopathies
3) benign and malignant diseases of pleura
4) benign and malignant tracheal tumors
5) benign and malignant tumors of esophagus
6) cardiac tumors other than myxoma
7) CHD : not covered in the above list
5] Pharmacology:
*** antibiotics , antitubercular , antifungal and antiviral drugs
*** Pharmacology of drugs used in the treatment of
1) congestive cardiac failur
2) hypertension
3) angina pectoris
4) peripheral vascular disease
5) acidbase imbalance
6) supra ventricular and ventricular arrrhythemia
7) chemotherapy of carcinoma lung
*** Pharmacology of drugs used as
1) oral and parenteral anti coagulants, antiplatelet agents, fibrinolytic agents, and their antidotes.
2) bronchodilators , mucolytics
3) systemic and pulmonary vasodilators conduit dilators for bypass grafts vasoconstrictors
4) diuretics
5) 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
1 * Function of the gas Exchange System and its Evaluation
2 * Anesthesia for CardioThoracic surgery.
3 *** Postoperative Care and complications in CardioThoracic surgery .
4 ** Ventilatory assistance and support. Respiratory support in infants
5 *** shock : types, diagnosis ,management. Cardio pulmonary resuscitation.
6 *** Use of Antibiotics in Cardiac and Thoracic Surgery
7 ** Computer Application in Cardio thoracic Surgery.
8 *** Thoracic Incisions, complications of incision including sternal dehiscence
9 *** Thoracic trauma.
10 ** Pulmonary resection Anatomy and Techniques.
11 ***Thoracic Imaging.
12 ** Esophagoscopy
13 ** Bronchoscopy: trans bronchial biopsy and bronchoalveolar lavage.
14 ** Thoracoscopy : general principles, diagnostic & therapeutic procedures
15 * Developmental Abnormalities of the airways and lungs
16 ***sequestration of lung,
17 * Surgical treatment of the Bullous Emphysema.
18 ***Diagnosis of Benign, diffuse Pulmonary Disease.
19 ***Pneumonia, Bronchiectasis, and lung abscess.
20 ** Thoracic infections caused by Actinomycetes, Fungi, Opportunistic organisms, and
Echinococcus.
21 ***Surgical treatment of tuberculosis
22 * Molecular biology and immunology of lung and esophageal cancer.
23 ** Benign tumors of the lower respiratory tract.
24 *** Lung carcinoma :diagnosis, staging, surgery for- ,limited pulmonary resection,
bronchoplastic techniques for
25 ** Multimodality Therapy of Carcinoma of the Lung: Irradiation, Chemotherapy, and
Immunotherapy.
26 * Indications for Resection of Pulmonary Metastases.
27 ** Thoracic disorders in an immunocompromised host
28 ** Pulmonary embolism acute & chronic
29 ** Pulmonary AV fistule
30 * Lung Transplantation.
31 ** Benign & Malignant Disorders of Pleura
32 *** Pleural Space Problems & Thoracoplasty
33 ***Thoracic Outlet Syndrome
34 ** Chest wall & sternal abnormalities & management of chest wall tumours
35 * Diaphragm : developmental, traumatic, neoplastic disorders, dysfunction & pacing
36 *** Mediastinal tumours, Thymic tumors and managemnt of myesthenia gravis
37 ** Trachea : tumors , strictures , tracheomalacia ,tracheal resections & reconstructions .
38 ** The Esophagus : Anatomy & Functional Evaluation .
39 ** Esophageal injuries
40 * Medical & Surgical Treatment of Hiatal Hernia .
41 * Barrette's Esophagus.
42 * Nissen Fundoplication .
43 * Hill Procedure .
44 * Belsey Mark IV Procedure.
45 * Benign Strictures of Esophagus .
46 * Paraoesophageal Hiatal Hernia.
47 * Esophageal Dysmotility.
48 * Treatment of Achalasia & Gastroesophagial Reflux.
49 ** Thoracoscopic Esophageal Surgery .
50 * Carcinoma of Esophagus, surgical options Resection, Reconstruction, Palliative
treatment of Carcinoma of the Esophagus .
51 ***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.
52 ** Normal & Abnormal Development of the Heart.
53 *** Peri operative care of the pediatric cardiac patient.
54 * Anesthesia for Pediatric Cardiac Surgery.
55*** Management of Cardiopulmonary Bypass in adults,infants & children .Pump,
oxygenators, fiters, tubings, cannule, ultrafiltration for CPB
56 *** Deep Hypothermia & Total Circulatory Arrest.
57 *** Myocardial Protection & cardioplegia: rational of various constituents, common
cardioplegic solutions. Constitution of cardioplegia used at the candidates institute.
58 *** Palliative Procedures in Congenital Heart Disease
59 ** Tracheoesophageal Compressive Syndromes of Vascular Origin: Rings & Slings.
60 *** Anomalous Pulmonary and Systemic Venous Connections.
61 *** Atrial Septal Defects and Cor Triatriatum.
62 *** Ventricular Septal Defect.
63 *** Patent Ductus Arteriosus and Aortopulmonary Window.
64 *** Atrioventricular Septal Defects.
65 *** Tetrology of Fallot and related physiological complexes
66 *** Complex of Functional Single Ventricle.
67 ** Truncus Arteriosus.
68 ** Congenital Malformations of the Aortic Valve and LVoutflow tract.
69 *** Coarctation of Aorta and Interrupted Aortic Arch.
70 ** Hypoplastic Left Heart Syndrome.
71 *** Pulmonary Stenosis with intact IVS
72 *** Pulmonary Atresia with intact IVS
73 *** Transposition of Great Arteries
74 *** Congenitally Corrected Transposition of the Great Arteries.
75*** Double Outlet Right Ventricle and Double Outlet Left Ventricle.
76 *** Tricuspid Atresia.
77 *** Ebstein's Anomaly
78 ** Congenital Abnormalities of the Mitral Valve.
79 * Heart & heart - lung transplantation in children
80 * Circulatory Support in Infants and Children
81 ** Anomalies of the Coronary Vessels
82 *** Hemorrhagic and Thrombotic Complications of Cardiac Surgery.
83 *** Intra-aortic Balloon Counter pulsation,Ventricular Assist Pumping,
84 * Artificial Heart.
85 ** Preservation of Intrathoracic Organs for Transplantation.
86 ** Heart & heart-lung Transplantation.
87 ** Cardiomyoplasty, surgical treatment for congestive cardiomyopathies.
88 *** Surgery for Bacterial Endocarditis.
89 *** Acquired Disease of the Tricuspid Valve.
90 *** Acquired Disease of the Mitral Valve.
91 *** Acquired Aortic Valve Disease
92 ** Surgical management of Hypertrophic Cardiomyopathies
93*** Homografts and Auto grafts
94 *** Cardiac Valvular Prostheses: design, selection, complications of
95*** 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.
96 ** Surgery for supraventricular & ventricular Arrhythmias.pacemaker therapy.
97 *** Aneurysms of the ascending , arch and descending thoracic aorta
98 *** Dissections of the Aorta.
99 *** Constrictive pericarditis, cardiac tamponade
100 * Other diseases of pericardium.
101 *** Cardiac myxoma
102 * Cardiac Tumors.
103 *** 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
104 ** legends in CVT surgery
105*** Prosthetic material ( biological / artificial) in Cardio, vascular and thoracic surgery
106*** Sutures in CVT Surgery: physical properties of sutures, needle types,
recent advances in suture materials.
Vascular
1. ***Physiologic assessment of peripheral arterial occlusive disease
2. ***vascular imaging techniques
3. ***Burger's disease
4. ***Takayasu's disease , Nonspecific aortoarteritis
5. *** management of arterial aneurysms
6. **fibrodysplasia
7. *uncommon arteriopathy
8. ***antithrombotic therapy
9. **angioplasties and endovascular techniques
10.***basic vascular surgical technique, Fogarty thrombectomy, endarterectomy
11.*** Vascular grafts
12.*** Complications of vascular surgery and interventions
13.***management of acute ischemia of limbs
14.***management of chronic ischemia of limbs and viscera
15.*** management of thoracic outlet syndrome
16.** other neurovascular conditions involving the upper extremity
17.* congenital vascular malformations
18.*** management of renovascular hypertension
19.***management of extracranial cerebrovascular disease
20.* * management of deep venous thrombosis