Download Free Medical Presentation and management of cardiac surgical diseases PowerPoint Presentation

Presentation and management of cardiac surgical diseases PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical PowerPoint presentation titled "Presentation and management of cardiac surgical diseases".

This medical PowerPoint presentation talks about diseases of heart, where surgery can play a role, surgical indications and the Basic Principles of Cardiac Surgery.

Tags : management of cardiac surgical diseases, surgical indications, Principles of Cardiac Surgery, Cardiothoracic Surgery, cardiology, cardiology PowerPoint presentation

Published on : Mar 19, 2023 | Views : 1534 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Presentation and management of cardiac surgical diseases Division of Cardiac Surgery Department of Cardiac Sciences King Saud University Medical city King Saud University, Riyadh.
Slide 2-

Objectives of the lecture Overview of diseases of heart, where surgery can play a role Surgical indications Understanding of the Basic Principles of Cardiac Surgery
Slide 3-

Cardiac Diseases Coronary Artery Disease Valvular Heart Diseases Congenital Heart Diseases Miscellaneous : Aortic Diseases Pericardial Disease Cardiac Tumors Trauma Heart failure Arrhythmia surgery
Slide 4-

Approach: 1. History 2. Physical examination 3. Chest x-ray 4. E.C.G. 5. Investigations (non-invasive & invasive). Surgery for Cardio-thoracic Diseases
Slide 5-

Modes of Presentation of Cardiac Diseases Chest pain Shortness of Breath Palpitations Dizziness, Syncope Congestive Cardiac Failure Cyanosis and Clubbing in Congenital Defects Other Symptoms (fever, sweating, G.I. symptoms, embolic symptoms, loss of weight)
Slide 6-

Surgery for Cardio-thoracic Diseases Chest pain Differential diagnosis: 1. Cardiac causes 2. Non-cardiac causes Life threatening causes: Myocardial infarction Aortic dissection Pulmonary embolism.
Slide 7-

Shortness of breath Cardiac causes: Heart failure, myocardial ischemia, congenital heart disease, arrhythmias, pericardial diseases, and valvular heart diseases. Respiratory causes: COPD, pneumothorax, infections, pulmonary embolism, pleural effusion, restrictive ling disease. Surgery for Cardio-thoracic Diseases
Slide 8-

Shortness of breath Others: Anemia, renal failure, obesity, anxiety and hyperthyroidism. Surgery for Cardio-thoracic Diseases
Slide 9-

Ischemic Heart Disease Clinical manifestations: 1. Asymptomatic 2. Symptomatic: -angina pectoris: stable- unstable -myocardial infarction -V.S.D., Ischemic mitral regurge, Ventricular aneurysm, Heart failure, Conduction defects.
Slide 10-

Ischemic Heart Disease Indications of surgery: 1. Failure of medical therapy or percutaneous intervention. 2. Left main disease more than 50%. 3. proximal LAD & proximal Cx more than 70%. 4. 3-vessel disease with left ventricular dysfunction 5. Mechanical complications of myocardial infarction. 6. Associated valve disease
Slide 11-

ppt slide no 11 content not found
Slide 12-

Surgery for Cardio-thoracic Diseases Coronary conduits: 1. Arterial: Internal thoracic artery 2. Venous : Long saphenous vein. Types of surgery: 1. Conventional: using the heart lung machine, and cardioplegic arrest 2. Off-pump (beating heart surgery)
Slide 13-

ppt slide no 13 content not found
Slide 14-

ppt slide no 14 content not found
Slide 15-

ppt slide no 15 content not found
Slide 16-

ppt slide no 16 content not found
Slide 17-

ppt slide no 17 content not found
Slide 18-

Coronary Artery Bypass Grafting
Slide 19-

Coronary Artery Bypass Surgery
Slide 20-

ppt slide no 20 content not found
Slide 21-

Surgery for Cardio-thoracic Diseases Valvular Heart Diseases 1. Mitral stenosis: Etiology: Rheumatic, Congenital The natural progression of MS causes the mitral valve area to reduce by 0.1-0.3 cm per year. The progression from the onset of rheumatic fever to onset of signs of MS takes 10-20 years. The progression from signs of MS to mild symptoms of MS takes 10-20 years. The progression from mild symptoms to decompensation takes 10-20 years In patients with severe PH the mean survival is 3 years.
Slide 22-

Symptoms of mitral stenosis 1.Asymptomatic for many years. 2. Easy fatiguability. 3. Dyspnea, Orthopnea and PND. 4. Palpitations 5. Dysphagia, compression of left main bronchus Surgery for Cardio-thoracic Diseases
Slide 23-

Signs of mitral stenosis 1. Low volume pulse. 2. Irregular pulse. 3. Tapping non-displaced apex beat. 4. Loud S1 5. Mid-diastolic rumbling murmur. 6. signs of PH: central cyanosis, Loud P2, T.R. P.R. Surgery for Cardio-thoracic Diseases
Slide 24-

Surgery for Cardio-thoracic Diseases Mitral Stenosis Treatment: 1. Medical 2. Balloon valvuloplasty 3. Closed mitral commissurotomy 4. Open mitral commissurotomy 5. Mitral valve replacement / repair
Slide 25-

Mitral Valve
Slide 26-

Surgery for Cardio-thoracic Diseases 2. Mitral Regurgitation: Etiology: Rheumatic, Degenerative, Endocarditis, Ischemic, Traumatic Chronic mitral regurgitation: Rheumatic fever, Myxomatous degeneration, ischemic cardiomyopathy. Acute mitral regurgitation: chordal rupture, infective endocarditis, papillary muscle rupture following MI.
Slide 27-

Mitral Regurgitation Asymptomatic patients can have a long latent period before the onset of symptoms as chronic M.R is well tolerated if L.V function is still preserved. Surgery for Cardio-thoracic Diseases
Slide 28-

Mitral Regurgitation Symptoms of mitral regurgitation: 1. fatigue and weakness 2. Dyspnea, Orthopnea, PND 3. Pulmonary hypertension and right heart failure. Surgery for Cardio-thoracic Diseases
Slide 29-

Mitral Regurgitation Signs of mitral regurgitation: 1. displaced apex beat 2. apical thrill 3. apical pan-systolic murmur 4.signs of pulmonary hypertension Surgery for Cardio-thoracic Diseases
Slide 30-

Mitral Valve
Slide 31-

Mitral Valve replacement
Slide 32-

Mitral Valve Repair
Slide 33-

Surgery for Cardio-thoracic Diseases Aortic stenosis Etiology: Rheumatic, Congenital, Degenerative. Symptoms: Asymptomatic Chest pain Syncopal attacks Dyspnea and CHF
Slide 34-

Aortic stenosis Signs of aortic stenosis: 1. slow-rising pulse 2. small amplitude pulse 3. sustained apical pulse 4. harsh ejection systolic murmur. Surgery for Cardio-thoracic Diseases
Slide 35-

Aortic Valve
Slide 36-

Aortic Stenosis
Slide 37-

Surgery for Cardio-thoracic Diseases Aortic regurgitation Etiology: Rheumatic, Endocarditis, Connective tissue disorders, Aortic dissection or aneurysm.
Slide 38-

Aortic Valve
Slide 39-

Aortic Regurgitation
Slide 40-

Valvular Prostheses
Slide 41-

Valvular Prostheses Surgery for Cardio-thoracic Diseases
Slide 42-

Surgery for Cardio-thoracic Diseases Valvular Prostheses Complications of prosthetic valves: 1. Thrombosis 2. Bleeding complications 3. Infective endocarditis 4. Paravalvular leak 5. Degeneration of biological valves
Slide 43-

Endocarditis
Slide 44-

Heart Failure Ventricular Assist Devices:
Slide 45-

Heart Failure Indications for Heart Transplant:
Slide 46-

Heart Failure
Slide 47-

Arrhythmia
Slide 48-

Surgery for Cardio-thoracic Diseases Thoracic Aortic Disease 1. Thoracic aortic aneurysm Symptoms are usually due to pressure on surrounding stuctures. 2. Aortic dissection: Tear in the intima allowing blood to enter and flow in a false channel. There are 2 lumens separated by the dissecting membrane
Slide 49-

Type A dissections Arising in the ascending aorta Are a medical emergency and require immediate surgery. Mortality rate up to 5% per hour. Surgery for Cardio-thoracic Diseases
Slide 50-

Type B dissections Arising in the descending aorta Carry a lower mortality rate and can be managed medically May cause symptoms due to vascular compromise to other areas e.g. acute limb ischemia, renal ischemia, paraplegia, mesenteric ischemia. Surgery for Cardio-thoracic Diseases
Slide 51-

Aortic Dissection DeBakey classification system Type I - Originates in ascending aorta, propagates at least to the aortic arch and often beyond it distally. Type II – Originates in and is confined to the ascending aorta. Type III – Originates in descending aorta, rarely extends proximally but will extend distally. Daily (Stanford) classification system Divided into 2 groups; A and B depending on whether the ascending aorta is involved. A = Type I and II DeBakey B = Type III DeBakey
Slide 52-

Aortic Disease
Slide 53-

Aortic Disease
Slide 54-

Aortic Surgery
Slide 55-

Surgery for Cardio-thoracic Diseases
Slide 56-

Surgery for Cardio-thoracic Diseases
Slide 57-

Surgery for Cardio-thoracic Diseases
Slide 58-

Cardiac Tumors
Slide 59-

Surgery for Cardio-thoracic Diseases Basic Principles of Cardiac Surgery Adequate Exposure Full or Partial Sternotomy / Thoracotomy / Robotic or Endoscopic Bloodless Operative Field Suction and re-transfusion / Snaring or clamping of bleeding vessels Static Operative Target Cardiac Arrest / Ventricular Fibrillation / Mechanical Stabilizers Preservation of body perfusion Use of Heart Lung Machine / Off-pump Techniques Preservation of Myocardium Off-pump Techniques / Hypothermia / Cardiac Arrest with cardioplegia
Slide 60-

Surface Cooling Hypothermia (28c˚) for ASD Closure in Children, 1952
Slide 61-

ppt slide no 61 content not found
Slide 62-

In 1953, John Gibbon reported the first successful ASD closure using his heart-lung machine. It took him 20 years of work and experiments!
Slide 63-

Heart Lung Machine Aim of cardiopulmonary bypass: The principal aim of CPB is to facilitate cardiac and thoracic aortic procedures by excluding the heart and lungs from the circulation whilst providing: 1. adequate gas exchange 2. systemic organ perfusion 3. controlling body temp. Surgery for Cardio-thoracic Diseases
Slide 64-

Surgery for Cardio-thoracic Diseases Heart Lung Machine Components : Roller pumps Blood Reservoir (cardiotomy reservoir) Oxygenator Heater-cooler unit Tubing and Monitoring console etc Limitation/Problems : Requires full anticoagulation Can cause micro embolism Initiates Systemic Inflammatory Response
Slide 65-

ppt slide no 65 content not found
Slide 66-

ppt slide no 66 content not found
Slide 67-

ppt slide no 67 content not found
Slide 68-

ppt slide no 68 content not found
Slide 69-

ppt slide no 69 content not found
Slide 70-

Complications of CPB 1. systemic inflammatory response due to contact of blood with the foreign surface of CPB circuit resulting in increased capillary permeability, interstitial edema, and subsequent organ dysfunction. 2. coagulopathy caused by platelet dysfunction as well as dilution and consumption of coagulation factors. Surgery for Cardio-thoracic Diseases
Slide 71-

Complications of CPB 3. hemolysis. 4. renal and splanchnic hypoperfusion 5. cerebrovascular accident Surgery for Cardio-thoracic Diseases
Slide 72-

Coronary Artery Bypass Surgery
Slide 73-

Surgery for Cardio-thoracic Diseases Heart Lung Machine
Slide 74-

Surgery for Cardio-thoracic Diseases Pericardial effusion Progressive accumulation of fluid inside the pericardial cavity, may compress the cardiac chambers. Etiology: -Traumatic -pericarditis -malignancy -uremia, post irradiation -postoperative.
Slide 75-

Surgery for Cardio-thoracic Diseases Pericardial effusion Investigations: -Plain x-ray chest -Echocardiography -CT scan Management: - treat the cause -Aspiration -Pericardiostomy
Slide 76-

Surgery for Cardio-thoracic Diseases
Slide 77-

Surgery for Cardio-thoracic Diseases Congenital Heart Diseases 1. Acyanotic: -Patent ductus arteriosus -Coarctation of the aorta -Pulmonary stenosis -Atrial septal defect -Ventricular septal defect
Slide 78-

Surgery for Cardio-thoracic Diseases Congenital Heart Diseases 2. Cyanotic: -Tetralogy of Fallot -Transposition of the great vessels -Tricuspid atresia -Total anomalous venous drainage -Truncus arteriosus
Slide 79-

Surgery for Cardio-thoracic Diseases Pre-Operative Investigations for Cardiac Surgery Full Blood Count Blood Biochemistry ECG Chest X-ray Pulmonary Function Tests. Other test according to systemic review of patient Echocardiography Angiography Carotid Duplex Scan Peripheral Duplex Scan
Slide 80-

Surgery for Cardio-thoracic Diseases Usual Duration of Stay in Hospital One day before surgery 3-6 hours OR time One day in ICU 4-5 Days in Ward Total 5-7 days
Slide 81-

Cardiac Trauma Blunt Penetrating In blunt cardiac trauma, the major challenge is diagnosis, while in penetrating cardiac trauma, the major challenges are rapid resuscitation followed by emergent definitive surgery Surgery for Cardio-thoracic Diseases
Slide 82-

Blunt Cardiac Trauma Myocardial contusion Pericardial tamponade Arrhythmia with cardiac arrest Disruption of valves and septum Coronary artery injuries Cardiac rupture Surgery for Cardio-thoracic Diseases
Slide 83-

Blunt Cardiac Trauma All patients with blunt chest trauma should undergo physical examination, CXR, ECG, and baseline cardiac enzymes. ECHO, C.T. may be needed Treatment depends on the nature of the injury. Surgery for Cardio-thoracic Diseases
Slide 84-

Penetrating Cardiac Trauma All patients with penetrating wounds between the right mid-clavicular and left mid-axillary lines from the epigastrium to the clavicles should be assumed to have injuries involving the heart until proven otherwise. Surgery for Cardio-thoracic Diseases
Slide 85-

Penetrating Cardiac Trauma The most commonly injured chamber is the right ventricle. The typical patient presents with signs of tamponade or hemorrhage. Emergent surgical exploration may be needed. Surgery for Cardio-thoracic Diseases
Slide 86-

ppt slide no 86 content not found