Thoracic Surgery Training Program

Goals and Objectives

Pediatric Cardiothoracic Rotation

Overall Objective: Understand the anatomy, physiology, and pathophysiology of the disease processes outlined in the TSDA Curriculum Section VII (Congenital Heart Disease) and Section X (Transplantation). Develop clinical skills to diagnose and determine the most appropriate treatment plan for patients with these specific disease processes. Develop clinical / technical skills for intraoperative treatment of basic congenital abnormalities (PDA, ASD, VSD, congenital lung abnormalities). Understand clinical / technical skills for intraoperative treatment of complex congenital abnormalities. Develop patient care skills for intensive care, elective postoperative care, and outpatient follow-up of patients undergoing pediatric cardiothoracic procedures.

Specific Clinical Skills:

1. Develop knowledge sufficient to be an effective first assistant. The importance of first assisting cannot be overemphasized since it is not possible to be an effective operative pediatric cardiothoracic surgeon without being able to first assist.
2. Understand conduct of cardiac surgical operations to include:
   1. Basic fundamentals of pediatric cardiopulmonary bypass
   2. Anesthesia issues during post-bypass period
   3. Understand intraoperative decision-making – i.e., techniques for correction
   4. Understand pediatric myocardial protection
   5. Understand weaning from cardiopulmonary bypass
   6. Understand pharmacologic manipulation in postoperative period
3. Develop independent skills in progression to include:
   1. Sternotomy / Thoracotomy
   2. Chest closure
   3. Cannulation
      1. Single-stage venous
      2. Dual-stage venous
      3. Arterial cannulation
      4. Cannulation for cardioplegia
   4. Closure of Patent Ductus Arteriosus
   5. Closure of Atrial Septal Defect
      1. Primary repair
      2. Patch repair
   6. Closure of Ventricular Septal Defect
      1. Primary repair
      2. Patch repair
      3. Distal anastomosis
4. Understand techniques for reoperative pediatric surgery
5. Understand progression of operations for complex congenital abnormalities
6. Understand conduct of pediatric heart and lung transplantation