PRESENTED BY : REETI SINGH B . P.

T FINAL YEAR

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DEFINITION AND TYPES
Cardiac surgery is defined as any surgery on the vessels or valves of the heart. It’s 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.

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CARDIOPULMONARY BYPASS Great majority of procedures are carried out with aid of cardiopulmonary bypass. In 3 . this the circulation through heart is interrupted so that surgeon can see the internal defect.

 Venous blood is transported from right atrium via clear plastic tubing to an oxygenator . The pumping action of the heart and gas exchange function of lungs are temporarily replaced by mechanical device. 4 . and then filtered and pumped back into aortic arch.

Blood is filtered before being returned to patient.  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. 5 . The pump and oxygenator are mounted together on a frame close to ground beside the operating table.

Membrane oxygenator : these work on the principle of semi-permeable membrane which separates the stream of oxygen gas from a film of blood.2 . 6 .

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INCISIONS USED IN OPEN HEART SURGERY  For operations on heart the approach is usually from front. 9 .through the 4th intercostal spaces and a transversely divided sternum. Vertical approach : median sternotomy is the most commonly used anterior incision. 2 approaches are used: 1. Sternum is divided longitudinally and retracted.Transverse approach : it is submammary and bilateral . 2 .

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 Congenital heart diseases : Co. 11 . Patent Ductus Arteriosus.arctation of aorta Tetralogy of Fallot.INDICATIONS FOR SURGERY  Ischaemic heart disease. Ventricular septal defect. Atrial septal defect.  Valve disease like stenosis and regurgitation.

12 .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.

 Long term complication is restenosis which occurs in 1/3rd of cases.  13 .Acute complications : Occlusion of a side branch by thrombus or a loose flap of intima and consequent myocardial damage.

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Graft failure. 3 . 2 . Haemorrhage . 4 . Post operative myocardial infarction. Dysrhythmias .CORONARY ARTERY BYPASS GRAFTING (CABG)  The internal mammary arteries . 5 . Cerebrovascular accident .  Post operative complications : 1 . radial artery or reversed segments of patients own saphenous vein can be used to bypass coronary artery stenoses. 17 .

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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 .COMPARISION B/W PTCA AND CABG PTCA < 0. DIFFUSE MYOCARDIAL 20 .36 HOURS 2 -5 DAYS 15 – 20 % AT 6 MONTHS M.5 % DEATH CABG < 1.5% 2% 12.

The approach is via left anterolateral thoracotomy through 4th or 6th intercostal space. The mitral valve is then dilated with help of dilator inserted into the left ventricle via the apex.  21 . It is termed closed because mitral valve is not seen but only felt with index finger inserted into the left atrium . Complications : mitral regurgitation and mortality less than 1%.VALVE REPAIR CLOSED MITRAL VALVOTOMY : INDICATED for mitral stenosis.

Valve stenosis and regurgitation. Types of valves : 1. 2 . VALVE REPLACEMENT SURGERY : INDICATIONS : 1 . Calcified and stiff valve. Mechanical valves 22 . Biological valves 2.

BIOLOGICAL VALVES MECHANICAL VALVES Obtained from pig or human heart . Preserved in glutaral dehyde. Is for lifelong. 23 . Requires antibiotics and anticoagulants. Does not require antibiotics or anticoagulants. Degenerates in 10 years. Artificial in nature and available in ball cage and disc types.

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T H A N K Y O U 27 .