Surgery in Cardiothoracic

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

2 CHEST TRAUMA

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4 Mediastinal emphysema
Subcutaneous emphysema Mediastinal emphysema

5 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

6 4 Life-threatening chest injuries
Tension pneumothorax Open pneumothorax Massive hemothorax Flail-chest

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

8 Water Seal Drainage One bottle system Three bottle system

9 Indications of Chest Tube Thoracostomy (CTT)
Pneumothorax Spontaneous pneumothorax Open or tension pneumothorax Traumatic pneumothorax Iatrogenic pneumothorax Hemothorax Pleural effusion Empyema Chylothorax

10 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

11 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

12 Thoracic incisions Median sternotomy Posterolateral thoracotomy
Anterolateral thoracotomy Clamshell incision Trap door incision Thoracoscopy = Video Assisted Thoracoscopy Surgery (VATS)

13 Anterolateral thoracotomy
Median sternotomy Trap door incision Clamshell incision Posterolateral thoracotomy

14 Thoracotomy Tumor mediastinum Tumor paru Posterolateral thoracotomy

15 Empyema kronis Decortication thoracotomy

16 Lobectomy Bilobectomy Pneumonectomy Pectus excavatum repair

17 Pericarditis Infectious Viral Tuberculosis Pyogenic bacteria
Non-infectious Post myocardial infection Uremia Neoplastic disease Radiation-induced Connective tissue disease Drug-induced

18 Cardiac tamponade Symptoms: Beck’s triad Jugular venous distention
Hypotension Muffled Heart Sound Sinus tachycardia Pulsus paradoxus Dyspnea, tachypnea Diagnosis  Echocardiography

19 Pericardiocentesis Suatu prosedur untuk mengaspirasi cairan dari rongga perikardium Indikasi: tamponade jantung

20 Pericardiotomy = Pericardial window

21 Pericardiectomy Tindakan pembedahan untuk membuang perikardium.
Indikasi: constrictive pericarditis, perikardium yang mengalami kalsifikasi dan fibrosis

22 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)

23 Bedah jantung Tertutup  jantung tetap berdenyut, tanpa Cardio-pulmonary bypass (heart-lung machine) Terbuka  dengan Cardio-pulmonary bypass (CPB)

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25 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

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27 Bedah Pintas Koroner = CABG (Coronary Artery Bypass Grafting)

28 Coronary Artery Disease / Penyakit Jantung Koroner

29 Diagnosis of Coronary Artery Disease
Exercise Stress Test Thallium Perfusion Scan Echocardiography

30 CORONARY ANGIOGRAPHY Melihat lokasi, luas, tingkat stenosis, dan kualitas arteri koronaria yang bisa di bypass

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32 Indications for coronary arteriography
Angina Pectoris Acute Myocardial Infarction Post infarction angina Recurrent infarction Age > 40 years old with Valvular Heart Disease

33 Anatomi klep jantung

34 Pathologic processes Rheumatic Heart Disease Myxomatous degeneration
Endocarditis Idiopathic, Marfan’s syndrome

35 Aortic valve replacement
Aortic stenosis Aortic regurgitation

36 Mitral valve replacement
Mitral stenosis Mitral regurgitation

37 Choice of valve Bioprosthetic valve Mechanical valve
Low thromboembolism No anticoagulation Durability  10 years Mechanical valve Systemic anticoagulation (+) Durability  > 20 years

38 Penyakit jantung kongenital
ASD VSD Tetralogy of Fallot

39 Ascending and descending thoracic aortic aneurysm Abdominal aortic aneurysm
Aneurisma: dilatasi abnormal pembuluh darah > 2 kali ukuran diameter normal

40 Abdominal Aortic Aneurysmectomy + Dacron graft interposition

41 Suprarenal Aneurysm Mr.T, 51 y.o.

42 Suprarenal Aneurysm Mr.T, 51 y.o.

43 Aortic dissection A tear in the intima of the aorta

44 Acute Aortic Dissection Thoracic Endovascular Aortic Repair (TEVAR)

45 Hybrid Aortic Surgery Combination of endovascular and open surgery

46 TERIMA KASIH