Transcript 16. Surgery in Cardiothoracic

Surgery in Cardiothoracic
dr. 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
 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

4 Life-threatening chest injuries
Tension pneumothorax
 Open pneumothorax
 Massive hemothorax
 Flail-chest

Pemasangan chest tube

Location of CTT: ICS 5-6, midaxillary line
Chest tube size  24 or 28 F
Indikasi: Re-ekspansi
paru-paru secepatnya
Water Seal Drainage
One bottle system
Three bottle system
Indications of Chest Tube Thoracostomy
(CTT)

Pneumothorax
 Spontaneous
pneumothorax
 Open or tension pneumothorax
 Traumatic pneumothorax
 Iatrogenic pneumothorax
Hemothorax
 Pleural effusion
 Empyema
 Chylothorax

Jenis Operasi Toraks
1. Chest tube thoracostomy/CTT dengan
water seal drainage dgn/tanpa suction
2. Reseksi paru
 Reseksi
baji
 Segmentectomy
 Lobectomy/Bilobectomy Sleeve Lobectomy
 Pneumectomy sleeve pneumectomy
3. Pengangkatan tumor mediastinum
 thymoma
- kista dermoid
 teratoma
- thyroid retro sternal
 neurofibroma
- kista perikardial
4. Trauma toraks
 Perdarahan masif dinding toraks/intra toraks
 Trauma penetrans (robekan beberapa organ
intratorakal)
 Tamponade jantung (pericardiocentesis,
pericardial window
 Ruptur diafragma
Thoracic incisions
Median sternotomy
 Posterolateral thoracotomy
 Anterolateral thoracotomy
 Clamshell incision
 Trap door incision


Thoracoscopy = Video Assisted
Thoracoscopy Surgery (VATS)
Anterolateral thoracotomy
Posterolateral thoracotomy
Median sternotomy
Trap door incision
Clamshell incision
Thoracotomy
Tumor mediastinum
Posterolateral thoracotomy
Tumor paru
Tumor mediastinum
Empyema kronis
Decortication thoracotomy

Lobectomy

Bilobectomy
Pectus excavatum repair
Pneumonectomy
Pericarditis
Infectious
 Viral
 Tuberculosis
 Pyogenic bacteria
 Non-infectious
 Post myocardial infection
 Uremia
 Neoplastic disease
 Radiation-induced
 Connective tissue disease
 Drug-induced

Cardiac tamponade
Symptoms:
 Beck’s triad
 Jugular venous distention
 Hypotension
 Muffled Heart Sound
 Sinus tachycardia
 Pulsus paradoxus
 Dyspnea, tachypnea
Diagnosis  Echocardiography
Pericardiocentesis

Suatu prosedur untuk
mengaspirasi cairan
dari rongga
perikardium

Indikasi: tamponade
jantung
Pericardiotomy = Pericardial window
Pericardiectomy

Tindakan
pembedahan untuk
membuang
perikardium.

Indikasi: constrictive
pericarditis,
perikardium yang
mengalami kalsifikasi
dan fibrosis
Jenis Kasus Kelainan Jantung yang
memerlukan pembedahan
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)
Bedah jantung
Tertutup  jantung tetap berdenyut,
tanpa Cardio-pulmonary bypass (heartlung machine)
 Terbuka  dengan Cardio-pulmonary
bypass (CPB)

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
Bedah Pintas Koroner = CABG
(Coronary Artery Bypass Grafting)
Coronary Artery Disease /
Penyakit Jantung Koroner
Diagnosis of Coronary Artery
Disease
Exercise Stress Test
 Thallium Perfusion Scan
 Echocardiography

CORONARY ANGIOGRAPHY
Melihat lokasi, luas, tingkat stenosis, dan kualitas
arteri koronaria yang bisa di bypass
Indications for coronary
arteriography
Angina Pectoris
 Acute Myocardial Infarction
 Post infarction angina
 Recurrent infarction
 Age > 40 years old with Valvular Heart
Disease

Anatomi klep jantung
Pathologic processes
Rheumatic Heart Disease
 Myxomatous degeneration
 Endocarditis
 Idiopathic, Marfan’s syndrome

Aortic valve replacement
Aortic stenosis
 Aortic regurgitation

Mitral valve replacement
Mitral stenosis
 Mitral regurgitation

Choice of valve

Bioprosthetic valve
 Low
thromboembolism
 No anticoagulation
 Durability  10 years

Mechanical valve
 Systemic
anticoagulation (+)
 Durability  > 20 years
Penyakit jantung kongenital
ASD
VSD
Tetralogy of Fallot
Ascending and descending
thoracic aortic aneurysm
Abdominal aortic aneurysm

Aneurisma: dilatasi
abnormal pembuluh
darah > 2 kali ukuran
diameter normal
Abdominal Aortic Aneurysmectomy +
Dacron graft interposition
Suprarenal Aneurysm
Suprarenal Aneurysm
Aortic dissection
A tear in the intima of the aorta
Acute Aortic Dissection
Thoracic Endovascular Aortic Repair
(TEVAR)
Hybrid Aortic Surgery
Combination of endovascular and open
surgery
TERIMA KASIH