Surgery in Cardiothoracic

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

2. CHEST TRAUMA

4. 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. JenisOperasiToraks 1. Chest tube thoracostomy/CTTdengan water seal drainage dgn/tanpa suction 2. Reseksiparu • Reseksibaji • Segmentectomy • Lobectomy/Bilobectomy Sleeve Lobectomy • Pneumectomy sleeve pneumectomy

11. 3. Pengangkatan tumor mediastinum • thymoma - kistadermoid • teratoma - thyroid retro sternal • neurofibroma - kistaperikardial 4. Trauma toraks • Perdarahanmasifdindingtoraks/intra toraks • Trauma penetrans (robekanbeberapa organ intratorakal) • Tamponadejantung (pericardiocentesis, pericardial window • Rupturdiafragma

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 Tumor mediastinum

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. JenisKasusKelainanJantung yang memerlukanpembedahan 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)

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

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 ANGIOGRAPHYMelihat lokasi, luas, tingkat stenosis, dan kualitas arteri koronaria yang bisa di bypass

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 • 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 aneurysmAbdominal 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 dissectionA tear in the intima of the aorta

44. Acute Aortic DissectionThoracic Endovascular Aortic Repair (TEVAR)

45. Hybrid Aortic SurgeryCombination of endovascular and open surgery

46. TERIMA KASIH