Surgery in Cardiothoracic

dr. Rachim Sobarna. Sp.B. Sp.BTKV (K)Cardiothoracic department of

Hasan Sadikin Hospital

CHEST TRAUMA

Subcutaneous emphysema

Mediastinal emphysema

4 Phases trauma patient

Primary surveyAirway with control cervical spineBreathing with oxygenCirculation with control external blood

lossDisability (neurological status)Exposure (control body temperature)

ResuscitationSecondary surveyDefinitive care

4 Life-threatening chest injuries

Tension pneumothoraxOpen pneumothoraxMassive hemothoraxFlail-chest

Pemasangan chest tube

Indikasi: Re-ekspansi paru-paru secepatnya

Location of CTT: ICS 5-6, midaxillary lineChest tube size 24 or 28 F

Water Seal DrainageOne bottle system

Three bottle system

Indications of Chest Tube Thoracostomy (CTT)

PneumothoraxSpontaneous pneumothoraxOpen or tension pneumothoraxTraumatic pneumothoraxIatrogenic pneumothorax

HemothoraxPleural effusionEmpyemaChylothorax

Jenis Operasi Toraks

1. Chest tube thoracostomy/CTT dengan water seal drainage dgn/tanpa suction

2. Reseksi paruReseksi bajiSegmentectomyLobectomy/Bilobectomy Sleeve

LobectomyPneumectomy sleeve pneumectomy

3. Pengangkatan tumor mediastinum thymoma - kista dermoid teratoma - thyroid retro sternalneurofibroma - kista perikardial

4. Trauma toraksPerdarahan masif dinding toraks/intra

toraksTrauma penetrans (robekan beberapa organ

intratorakal)Tamponade jantung (pericardiocentesis,

pericardial windowRuptur diafragma

Thoracic incisions

Median sternotomyPosterolateral thoracotomyAnterolateral thoracotomyClamshell incisionTrap door incision

Thoracoscopy = Video Assisted Thoracoscopy Surgery (VATS)

Anterolateral thoracotomy

Median sternotomy

Posterolateral thoracotomy

Clamshell incision

Trap door incision

Thoracotomy

Tumor paruTumor mediastinum

Posterolateral thoracotomy

Tumor mediastinum

Empyema kronis

Decortication thoracotomy

Lobectomy Bilobectomy Pneumonectomy

Pectus excavatum repair

Pericarditis

InfectiousViralTuberculosisPyogenic bacteria

Non-infectiousPost myocardial infectionUremiaNeoplastic diseaseRadiation-inducedConnective tissue diseaseDrug-induced

Cardiac tamponade

Symptoms: Beck’s triad

Jugular venous distentionHypotensionMuffled 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

Tertutup1. PDA2. Coarctatio aorta3. Shunting4. Pemasangan pacu jantung permanen

Terbuka1. Kelainan sekat (ASD, VSD)2. Kelainan katup Mitral, Aorta3. 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 TestThallium Perfusion ScanEchocardiography

CORONARY ANGIOGRAPHYMelihat lokasi, luas, tingkat stenosis, dan

kualitas arteri koronaria yang bisa di bypass

Indications for coronary arteriography

Angina PectorisAcute Myocardial InfarctionPost infarction anginaRecurrent infarctionAge > 40 years old with Valvular

Heart Disease

Anatomi klep jantung

Pathologic processes

Rheumatic Heart DiseaseMyxomatous degenerationEndocarditis Idiopathic, Marfan’s syndrome

Aortic valve replacement

Aortic stenosisAortic regurgitation

Mitral valve replacement

Mitral stenosisMitral regurgitation

Choice of valve

Bioprosthetic valveLow thromboembolismNo anticoagulationDurability 10 years

Mechanical valveSystemic 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 dissectionA tear in the intima of the aorta

Acute Aortic DissectionThoracic Endovascular Aortic Repair

(TEVAR)

Hybrid Aortic SurgeryCombination of endovascular and open

surgery

TERIMA KASIH