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CHAPTER 22

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  1. CHAPTER 22 Cardiothoracic Surgery

  2. Objectives • After studying this chapter, you will be able to: • Recognize the relevant anatomy of the cardiovascular and respiratory systems • Summarize the pathology that prompts cardiac or thoracic surgical intervention and the related terminology • Determine any special preoperative diagnostic procedures/tests for the patient undergoing cardiac or thoracic surgery

  3. Objectives (cont’d.) • Determine any preoperative preparation procedures • Indicate the names and uses of cardiovascular and thoracic equipment, instruments, and supplies • Summarize the surgical steps of the cardiac and thoracic procedures • Interpret the purpose and expected outcomes of the cardiac and thoracic procedures

  4. Objectives (cont’d.) • Recognize the immediate postoperative care and possible complications of the cardiac and thoracic procedures • Assess any specific variations related to the preoperative, intraoperative, and postoperative care of the patient undergoing a cardiac or thoracic procedure

  5. Part I: Thoracic Surgical Procedures • Introduction • Thoracic surgical procedures • Primary focus is the lungs • Includes treatment of chest wall deformities and identification of lesions within the mediastinum

  6. Diagnostic Procedures and Tests • Imaging studies used in diagnosis of thoracic diseases and disorders • Standard X-rays • Anteroposterior (AP) and lateral • CT scanning and MRI • Useful for evaluation of pericardial and intracardiac masses • Pulmonary angiography • Primarily used to detect pulmonary embolism and other blockages

  7. Diagnostic Procedures and Tests (cont’d.) • Other useful diagnostic procedures for the evaluation of cardiac disease • Electrocardiography • Echocardiography • Cardiac catheterization

  8. Instrumentation, Routine Equipment and Supplies • Instrumentation • Thoracic procedures: instruments needed to remove a rib (e.g., Bethune rib shears and Matson rib stripper/elevator) and expose and repair the organs of the thorax • Thoracotomy: vascular instrument set and thoracotomy instrument set • Refer to Tables 22-1 and 22-2

  9. Instrumentation, Routine Equipment and Supplies (cont’d.) • Anesthesia monitoring equipment • Swan-Ganz and arterial catheters • Electrocardiography equipment • Oxygen saturation equipment • Temperature equipment • Blood pressure equipment • Double-lumen endotracheal tube • Supplies • Refer to text for a list of routine supplies

  10. Thoracic Surgical Procedures • Include: • Bronchoscopy • Mediastinoscopy • Video-assisted thoracic surgery (VATS) • Nuss pectus excavatum repair by VATS • Pulmonary thromboendarterectomy • Decortication of the lung • Upper lobectomy • Pneumonectomy

  11. Part II: Adult Cardiac Surgical Procedures • Introduction • Cardiac surgery is typically performed in the largest room of the OR suite • Must accommodate a larger number of OR personnel and equipment • Cardiac patient may come from the cardiac care unit on an ICU bed with monitoring lines in place • Occasionally, the patient will be brought over from the cardiac catheterization lab

  12. Diagnostic Procedures and Tests • Useful diagnostic procedures for the evaluation of cardiac disease • Chest X-ray • CT scan and MRI • Electrocardiography • Echocardiography • Electrophysiology studies • Cardiac catheterization • Arteriograms

  13. Routine Instrumentation, Equipment, and Supplies • Most cardiac procedures require the same instrumentation, equipment, and supplies • Specialty items are added that are unique to the procedure • Instrumentation • Cardiac instrument set: refer to Table 22-3 • Equipment • Refer to text for a list of routine equipment

  14. Anatomy and Physiology of the Heart • Role of the heart within the cardiovascular system • Essential for blood circulation • Carries waste substances away from cells to excretory organs for elimination • Brings vital nutrients and oxygen from the respiratory and digestive organs to cells throughout the body

  15. Anatomy and Physiology of the Heart (cont’d.) • Location of the heart • Refer to Figure 22-15 • Coverings of the heart • Refer to Figure 22-16 • The heart wall: layers • Epicardium, myocardium, and endocardium • The heart chambers • Two atria and two ventricles

  16. Anatomy and Physiology of the Heart (cont’d.) • The heart valves • Atrioventricular valve • Tricuspid valve • Pulmonary semilunar valve • Mitral valve • Aortic semilunar valve • Chordae tendineae

  17. Anatomy and Physiology of the Heart (cont’d.) • Blood flow through the heart and blood supply for the heart • Refer to text for detailed description • Cardiac conduction • Cardiac conduction system coordinates the events of the cardiac cycle • Specialized areas of tissue transmit electrical impulses throughout the myocardium for the rhythmical activity of the heart

  18. Anatomy and Physiology of the Heart (cont’d.) • Techniques of cardiopulmonary bypass: refer to Figures 22-17 through 22-20 • Aortic cannulation • Venous cannulation • Left ventricular vent placement via the left atrium

  19. Adult Cardiac Surgical Procedures • Include: • Coronary artery bypass with grafting (CABG) • MID-CABG • OPCAB • Intra-aortic balloon pump (IABP) • Ventricular assist device (VAD) insertion • Orthotopic heart transplant • Ventricular aneurysm repair • Aortic valve replacement

  20. Mitral Valve Replacement • Procedure is similar to aortic valve replacement • Decision to replace the mitral valve depends on the severity of symptoms • Graded by New York Heart Association method • Mitral valve can be either repaired or replaced • Refer to text and Figures 22-32 and 22-33

  21. Mitral Valve Replacement (cont’d.) • Technique • Replacement of the mitral valve with a prosthesis • Refer to text and Figure 22-34

  22. Part III: Pediatric Cardiac Procedures • Introduction • Surgical procedures for repair of congenital heart defects • Repair of atrial septal defect (ASD) and ventricular septal defect (VSD) • Closure of patent ductus arteriosus (PDA) • Repair of coarctation of the aorta • Repair of tetralogy of Fallot (TOF)

  23. Part III: Pediatric Cardiac Procedures (cont’d.) • Preoperative preparation • Pediatric cardiac instruments are smaller and more delicate • Pediatric patients are at greater risk of hypothermia, therefore, OR temperature is generally raised • Blood loss should be closely monitored by the surgical team because of the pediatric patient’s low blood volume

  24. Pediatric Cardiac Procedures • Include: • Repair of ASD • Closure of patent ductus arteriosus (PDA) • Repair of coarctation of the aorta • Repair of TOF

  25. Summary • This chapter reviewed: • Anatomy of the cardiovascular and respiratory systems • The pathology that prompts cardiac or thoracic surgical intervention • Diagnostic procedures and tests • Cardiovascular and thoracic equipment, instruments, and supplies • Cardiac and thoracic surgical procedures