surgery in cardiothoracic n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Surgery in Cardiothoracic PowerPoint Presentation
Download Presentation
Surgery in Cardiothoracic

Loading in 2 Seconds...

play fullscreen
1 / 46

Surgery in Cardiothoracic - PowerPoint PPT Presentation


  • 524 Views
  • Uploaded on

Surgery in Cardiothoracic . d r. Rachim Sobarna. Sp.B. Sp.BTKV (K ) Cardiothoracic department of Hasan Sadikin Hospital. CHEST TRAUMA. Subcutaneous emphysema. Mediastinal emphysema. 4 Phases  trauma patient. Primary survey A irway with control cervical spine B reathing with oxygen

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Surgery in Cardiothoracic


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
    Presentation Transcript
    1. Surgery in Cardiothoracic dr. Rachim Sobarna. Sp.B. Sp.BTKV (K) Cardiothoracic department of Hasan Sadikin Hospital

    2. CHEST TRAUMA

    3. Subcutaneous emphysema Mediastinal emphysema

    4. 4 Phases  trauma patient • Primary survey • Airway with control cervical spine • Breathing with oxygen • Circulation with control external blood loss • Disability (neurological status) • Exposure (control body temperature) • Resuscitation • Secondary survey • Definitive care

    5. 4 Life-threatening chest injuries • Tension pneumothorax • Open pneumothorax • Massive hemothorax • Flail-chest

    6. Pemasangan chest tube • Indikasi: Re-ekspansi paru-paru secepatnya Location of CTT: ICS 5-6, midaxillary line Chest tube size  24 or 28 F

    7. Water Seal Drainage One bottle system Three bottle system

    8. Indications of Chest Tube Thoracostomy (CTT) • Pneumothorax • Spontaneous pneumothorax • Open or tension pneumothorax • Traumatic pneumothorax • Iatrogenic pneumothorax • Hemothorax • Pleural effusion • Empyema • Chylothorax

    9. JenisOperasiToraks 1. Chest tube thoracostomy/CTTdengan water seal drainage dgn/tanpa suction 2. Reseksiparu • Reseksibaji • Segmentectomy • Lobectomy/Bilobectomy Sleeve Lobectomy • Pneumectomy sleeve pneumectomy

    10. 3. Pengangkatan tumor mediastinum • thymoma - kistadermoid • teratoma - thyroid retro sternal • neurofibroma - kistaperikardial 4. Trauma toraks • Perdarahanmasifdindingtoraks/intra toraks • Trauma penetrans (robekanbeberapa organ intratorakal) • Tamponadejantung (pericardiocentesis, pericardial window • Rupturdiafragma

    11. Thoracic incisions • Median sternotomy • Posterolateral thoracotomy • Anterolateral thoracotomy • Clamshell incision • Trap door incision • Thoracoscopy = Video Assisted Thoracoscopy Surgery (VATS)

    12. Anterolateral thoracotomy Median sternotomy Trap door incision Clamshell incision Posterolateral thoracotomy

    13. Thoracotomy Tumor mediastinum Tumor paru Posterolateral thoracotomy Tumor mediastinum

    14. Empyema kronis Decortication thoracotomy

    15. Lobectomy Bilobectomy Pneumonectomy Pectus excavatum repair

    16. Pericarditis • Infectious • Viral • Tuberculosis • Pyogenic bacteria • Non-infectious • Post myocardial infection • Uremia • Neoplastic disease • Radiation-induced • Connective tissue disease • Drug-induced

    17. Cardiac tamponade Symptoms: • Beck’s triad • Jugular venous distention • Hypotension • Muffled Heart Sound • Sinus tachycardia • Pulsus paradoxus • Dyspnea, tachypnea Diagnosis Echocardiography

    18. Pericardiocentesis • Suatu prosedur untuk mengaspirasi cairan dari rongga perikardium • Indikasi: tamponade jantung

    19. Pericardiotomy = Pericardial window

    20. Pericardiectomy • Tindakan pembedahan untuk membuang perikardium. • Indikasi: constrictive pericarditis, perikardium yang mengalami kalsifikasi dan fibrosis

    21. JenisKasusKelainanJantung yang memerlukanpembedahan Tertutup 1. PDA 2. Coarctatio aorta 3. Shunting 4. Pemasangan pacu jantung permanen Terbuka 1. Kelainan sekat (ASD, VSD) 2. Kelainan katup Mitral, Aorta 3. Kelainan kongenital complicated (ToF, TGA, DORV) 4. Kelainan pembuluh koroner (CABG)

    22. Bedah jantung • Tertutup  jantung tetap berdenyut, tanpa Cardio-pulmonary bypass (heart-lung machine) • Terbuka  dengan Cardio-pulmonary bypass (CPB)

    23. Bedah jantung tertutup • Indikasi: • PDA • Kelainan kongenital pada jantung dimana duktus arteriosus gagal menutup segera setelah lahir • Coarctatio aorta • Kelainan kongenital dimana aorta mendekati menyempit di daerah sekitar duktus arteriosus yag mengalami regresi

    24. Bedah Pintas Koroner = CABG (Coronary Artery Bypass Grafting)

    25. Coronary Artery Disease / Penyakit Jantung Koroner

    26. Diagnosis of Coronary Artery Disease • Exercise Stress Test • Thallium Perfusion Scan • Echocardiography

    27. CORONARY ANGIOGRAPHYMelihat lokasi, luas, tingkat stenosis, dan kualitas arteri koronaria yang bisa di bypass

    28. Indications for coronary arteriography • Angina Pectoris • Acute Myocardial Infarction • Post infarction angina • Recurrent infarction • Age > 40 years old with Valvular Heart Disease

    29. Anatomi klep jantung

    30. Pathologic processes • Rheumatic Heart Disease • Myxomatous degeneration • Endocarditis • Idiopathic, Marfan’s syndrome

    31. Aortic valve replacement • Aortic stenosis • Aortic regurgitation

    32. Mitral valve replacement • Mitral stenosis • Mitral regurgitation

    33. Choice of valve • Bioprosthetic valve • Low thromboembolism • No anticoagulation • Durability  10 years • Mechanical valve • Systemic anticoagulation (+) • Durability  > 20 years

    34. Penyakit jantung kongenital ASD VSD Tetralogy of Fallot

    35. Ascending and descending thoracic aortic aneurysmAbdominal aortic aneurysm • Aneurisma: dilatasi abnormal pembuluh darah > 2 kali ukuran diameter normal

    36. Abdominal Aortic Aneurysmectomy + Dacron graft interposition

    37. Suprarenal Aneurysm Mr.T, 51 y.o.

    38. Suprarenal Aneurysm Mr.T, 51 y.o.

    39. Aortic dissectionA tear in the intima of the aorta

    40. Acute Aortic DissectionThoracic Endovascular Aortic Repair (TEVAR)

    41. Hybrid Aortic SurgeryCombination of endovascular and open surgery

    42. TERIMA KASIH