Date post: | 01-Jan-2016 |
Category: |
Documents |
Upload: | caleb-macias |
View: | 118 times |
Download: | 9 times |
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 surveyAirway with control cervical spineBreathing with oxygenCirculation with control external blood
lossDisability (neurological status)Exposure (control body temperature)
ResuscitationSecondary surveyDefinitive care
4 Life-threatening chest injuries
Tension pneumothoraxOpen pneumothoraxMassive hemothoraxFlail-chest
Pemasangan chest tube
Indikasi: Re-ekspansi paru-paru secepatnya
Location of CTT: ICS 5-6, midaxillary lineChest tube size 24 or 28 F
Water Seal DrainageOne bottle system
Three bottle system
Indications of Chest Tube Thoracostomy (CTT)
PneumothoraxSpontaneous pneumothoraxOpen or tension pneumothoraxTraumatic pneumothoraxIatrogenic pneumothorax
HemothoraxPleural effusionEmpyemaChylothorax
Jenis Operasi Toraks
1. Chest tube thoracostomy/CTT dengan water seal drainage dgn/tanpa suction
2. Reseksi paruReseksi bajiSegmentectomyLobectomy/Bilobectomy Sleeve
LobectomyPneumectomy sleeve pneumectomy
3. Pengangkatan tumor mediastinum thymoma - kista dermoid teratoma - thyroid retro sternalneurofibroma - kista perikardial
4. Trauma toraksPerdarahan masif dinding toraks/intra
toraksTrauma penetrans (robekan beberapa organ
intratorakal)Tamponade jantung (pericardiocentesis,
pericardial windowRuptur diafragma
Thoracic incisions
Median sternotomyPosterolateral thoracotomyAnterolateral thoracotomyClamshell incisionTrap door incision
Thoracoscopy = Video Assisted Thoracoscopy Surgery (VATS)
Anterolateral thoracotomy
Median sternotomy
Posterolateral thoracotomy
Clamshell incision
Trap door incision
Thoracotomy
Tumor paruTumor mediastinum
Posterolateral thoracotomy
Tumor mediastinum
Empyema kronis
Decortication thoracotomy
Lobectomy Bilobectomy Pneumonectomy
Pectus excavatum repair
Pericarditis
InfectiousViralTuberculosisPyogenic bacteria
Non-infectiousPost myocardial infectionUremiaNeoplastic diseaseRadiation-inducedConnective tissue diseaseDrug-induced
Cardiac tamponade
Symptoms: Beck’s triad
Jugular venous distentionHypotensionMuffled 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
Tertutup1. PDA2. Coarctatio aorta3. Shunting4. Pemasangan pacu jantung permanen
Terbuka1. Kelainan sekat (ASD, VSD)2. Kelainan katup Mitral, Aorta3. Kelainan kongenital complicated (ToF, TGA,
DORV)4. Kelainan pembuluh koroner (CABG)
Bedah jantung
Tertutup jantung tetap berdenyut, tanpa Cardio-pulmonary bypass (heart-lung 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 TestThallium Perfusion ScanEchocardiography
CORONARY ANGIOGRAPHYMelihat lokasi, luas, tingkat stenosis, dan
kualitas arteri koronaria yang bisa di bypass
Indications for coronary arteriography
Angina PectorisAcute Myocardial InfarctionPost infarction anginaRecurrent infarctionAge > 40 years old with Valvular
Heart Disease
Anatomi klep jantung
Pathologic processes
Rheumatic Heart DiseaseMyxomatous degenerationEndocarditis Idiopathic, Marfan’s syndrome
Aortic valve replacement
Aortic stenosisAortic regurgitation
Mitral valve replacement
Mitral stenosisMitral regurgitation
Choice of valve
Bioprosthetic valveLow thromboembolismNo anticoagulationDurability 10 years
Mechanical valveSystemic 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
Mr.T, 51 y.o.
Suprarenal Aneurysm
Mr.T, 51 y.o.
Aortic dissectionA tear in the intima of the aorta
Acute Aortic DissectionThoracic Endovascular Aortic Repair
(TEVAR)
Hybrid Aortic SurgeryCombination of endovascular and open
surgery
TERIMA KASIH