Surgery in Cardiothoracic dr. Rachim Sobarna. Sp.B. Sp.BTKV (K) Cardiothoracic department of Hasan Sadikin Hospital

CHEST TRAUMA

Mediastinal emphysema 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 Indikasi: Re-ekspansi paru-paru secepatnya Location of CTT: ICS 5-6, midaxillary line Chest tube size  24 or 28 F

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 Median sternotomy Trap door incision Clamshell incision Posterolateral thoracotomy

Thoracotomy Tumor mediastinum Tumor paru Posterolateral thoracotomy

Empyema kronis Decortication thoracotomy

Lobectomy Bilobectomy Pneumonectomy Pectus excavatum repair

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 (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 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 Mechanical 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 Mr.T, 51 y.o.

Suprarenal Aneurysm Mr.T, 51 y.o.

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