16. Surgery in Cardiothoracic
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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