PRESENTED BY : REETI SINGH B . P.

T FINAL YEAR

DEFINITION AND TYPES

Cardiac surgery is defined as any surgery on the vessels or valves of the heart. Its of 2 types : 1 . Closed heart surgery such as closed valvotomy , or PTCA (percutaneous transluminal coronary angioplasty). 2 . Open heart surgery done with the use of cardiopulmonary bypass.

CARDIOPULMONARY BYPASS
Great

majority of procedures are carried out with aid of cardiopulmonary bypass. this the circulation through heart is interrupted so that surgeon can see the internal defect.

In

 The

pumping action of the heart and gas exchange function of lungs are temporarily replaced by mechanical device.

Venous

blood is transported from right atrium via clear plastic tubing to an oxygenator , and then filtered and pumped back into aortic arch.
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 The

pump and oxygenator are mounted together on a frame close to ground beside the operating table.

Oxygenators

are of two types : 1 . Bubble oxygenator : it works on the principle of bubbling oxygen into a column of venous blood. The blood is arterialized as the oxygen bubbles rise. Blood is filtered before being returned to patient.
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2 . Membrane oxygenator : these work on the principle of semi-permeable membrane which separates the stream of oxygen gas from a film of blood.

INCISIONS USED IN OPEN HEART

SURGERY
For

operations on heart the approach is usually from front. 2 approaches are used: 1. Vertical approach : median sternotomy is the most commonly used anterior incision. Sternum is divided longitudinally and retracted. 2 .Transverse approach : it is submammary and bilateral ,through the 4th intercostal spaces and a transversely divided sternum.
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INDICATIONS FOR SURGERY

Ischaemic

heart disease. Valve disease like stenosis and regurgitation. Congenital heart diseases : Co- arctation of aorta Tetralogy of Fallot. Patent Ductus Arteriosus. Ventricular septal defect. Atrial septal defect.

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PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA)

It

is performed by passing a fine guidewire across a coronary stenosis under radiographic control and using it to position a balloon which is then inflated to dilate the stenosis. A coronary stent is a piece of coated metallic scaffolding that can be deployed on a balloon and used to maximise and maintain the dilatation of the stenosed vessel.

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Acute complications : Occlusion of a side branch by thrombus or a loose flap of intima and consequent myocardial damage. Long term complication is restenosis which occurs in 1/3rd of cases.

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CORONARY ARTERY BYPASS GRAFTING (CABG)

The

internal mammary arteries , radial artery or reversed segments of patients own saphenous vein can be used to bypass coronary artery stenoses. Post operative complications : 1 . Haemorrhage . 2 . Post operative myocardial infarction. 3 . Dysrhythmias . 4 . Cerebrovascular accident . 5 . Graft failure.

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COMPARISION B/W PTCA AND CABG

PTCA
< 0.5 % DEATH

CABG
< 1.5%

2%
12- 36 HOURS 2 -5 DAYS 15 20 % AT 6 MONTHS

M.I
HOSPITAL STAY RETURN TO WORK RECURRENT ANGINA

10%
5 8 DAYS 6 12 WEEKS 10 % AT 1 YEAR

RARE

NEUROLOGIC COMPLICATIO N
OTHER COMPLICATIO

STROKE

EMERGENCY CABG ,

DIFFUSE MYOCARDIAL

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VALVE REPAIR
CLOSED MITRAL VALVOTOMY : INDICATED for mitral stenosis.The approach is via left anterolateral thoracotomy through 4th or 6th intercostal space. It is termed closed because mitral valve is not seen but only felt with index finger inserted into the left atrium . The mitral valve is then dilated with help of dilator inserted into the left ventricle via the apex. Complications : mitral regurgitation and mortality less than 1%.

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 VALVE

REPLACEMENT SURGERY : INDICATIONS : 1 . Calcified and stiff valve. 2 .Valve stenosis and regurgitation. Types of valves : 1. Biological valves 2. Mechanical valves
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BIOLOGICAL VALVES

MECHANICAL VALVES

Obtained from pig or human heart . Preserved in glutaral dehyde. Does not require antibiotics or anticoagulants. Degenerates in 10 years.

Artificial in nature and available in ball cage and disc types.

Requires antibiotics and anticoagulants. Is for lifelong.
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T H A N K Y O U

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