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    Basic Cardiac Surgery For Residents

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    Intrusive Reader

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    Basic Cardiac Surgery For Residents

    Uploaded by

    Intrusive Reader
    21 views53 pages

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    Basic Cardiac Surgery for Residents

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views53 pages

    Basic Cardiac Surgery For Residents

    Uploaded by

    Intrusive Reader

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 53

    Basic cardiac surgery for

    residents
    Coronary Artery Dominance

    LCx

    PIV

    Left Dominance Right Dominance


    Ischemic Heart diseases
    • Ischemic heart diseases are a group of closely
    related syndromes, resulting from myocardial
    ischemia [an imbalance between the supply and
    demand of heart for oxygenated blood.],
    • CHD can manifest itself in any of the following
    ways
    – Angina Pectoris
    – Myocardial Infarction \ Heart Attack
    – Irregularities of the Heart
    – Cardiac failure
    – Sudden Death
    Risk Factors od coronary (ischemic)
    Heart Disease
    Non Modifiable Modifiable
    o Age o Cigarette smoking
    o Gender o High blood
    o Family history pressure
    o Genetic Factors o Elevated serum
    o Type A cholesterol
    Personality o Diabetes
    o Race o Obesity
    o Sedentary Habits
    o Stress
    Coronary Artery Disease (CAD)

    Angina
    Stable Unstable Angina
    Angina
    Non NSTMI STMI
    MI
    Acute Coronary Syndrome
    (ACS)
    Common Injury Pattern and Likely Culprit Vessels
    Affected Wall Primary Ischemic Pericardial Changed Most Likely
    Changes (e.g.ST (e.g. ST Culprit
    elevations, Q waves) depressions) Vessel
    Septal V1-V2 - LAD
    Anterior V3-V4, +/- V2, +/- V5 II, III, aVF LAD

    Lateral V5-V6, +/- I, +/- aVL II, III, aVF Cx

    High Lateral I and aVL only II, III, aVF LAD

    Inferior II, III, and aVF V2-V3 and/or I, aVL RCA or Cx

    Anteroseptal V1-V4 II, III, aVF LAD


    (Usually apical
    anterior)
    Anterolateral V3-V6, I, aVL II, III, aVF LAD

    Inferolateral II, III, aVF, V5-V6, +/- I, +/- V2-V3 Cx


    aVL
    The Role of Imaging in ACS
    1.Diagnosis
    2.Differential diagnosis Selected cases

    3.Infarct-related artery
    4.Functional infarct size
    5.Left ventricular function All cases
    6.Viability
    7.Prognosis
    8.Complications Selected cases
    Mammary artery
    harvesting
    Coronary Artery
    Anastomosis

    Vein Aorta
    Anastomosis
    Mammary artery
    anastomosis
    Mammary artery
    harvesting
    Coronary Artery
    Anastomosis

    Vein Aorta
    Anastomosis
    Total Arterial Revascularization
    • Contraindications of Radial Artery grafts
     Prior trauma/ operation
     Ca++, atheroma
     Allen’s test > 10 sec
     Scleroderma
     Subclavian artery stenosis
     Renal failure patients
     Cannulated radial artery for angiography/ stents
    Silent Complications
    • Pericardial Effusion
    • Apical LV thrombus
    • LV aneurysm
    • Contained
    pseudoaneurysm/ rupture
    Complications of Acute MI that may be
    Detected/Assessed by Echo/Imaging
    • Acute MR (papillary muscle displacement or
    rupture)
    • Ventricular septal rupture
    • Free wall rupture and pseudoaneurysm
    • Infarct expansion, aneurysm, LV
    remodeling
    • Thrombus
    • RV infarction
    • Pericardial effusion
    Quantification of Incomplete Revascularization and its Association With Five-Year Mortality in the
    Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial
    Validation of the Residual SYNTAX Score

    https://doi.org/10.1161/CIRCULATIONAHA.113.001803Circulation. 2013;128:141-151,
    Originally published July 8, 2013
    Total Arterial Revascularization
    • The radial artery ( useful with better results in )
     Elderly patients
     Obese diabetics
     Stripped/used SVG, leg ulcers
     Reoperations
     Sever COAD
    • It is more likely to achieve Multi or total arterial
    revascularization when using the radial artery conduit
    with a better long term results
    • Easy to harvest, long, robust
    • Fewer infections and wound problems
    • Good for sequential grafting
    The Anatomy of Heart Valve
    Anatomy of The Aortic
    Valve
    Diastol
    e

    Systole
    The Mitral Valve Leaflets
    Anatomy of The Mitral Valve Apparatus
    Open Pivot® Open Pivot vs. Cavity Pivot Cavity
    Pivots

    CarboMed On-X
    ics
    AT
    S

    St. Jude Medical Sorin

    50
    Tissue Valves

    •Bovine
    •Pericardial
    (stinted, nonstinted)

    •homograft

    51
    Mechanical Valves

    •Ball & cage


    •Monoleaflet
    •Bileaflet

    52

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