(精选)心脏外科 CARDIAC SURGERY教学课件.pptVIP

Dr.Hesham Noor, MBBCH,M.Sc.M.D;CARDIAC SURGERY;Valvular heart disease;Pathophysiology and Heamodyamics;Clinical Features;;;New York Heart Association classification NYHA;Indications for surgery; ;Prosthetic heart valves;;Mechanical valves;;Coronary artery surgery;;;;;;Investigations;;;Indications for surgery;What are the indications for CABG? ;What are the functional studies used to assess myocardial viability after myocardial infarction (MI)? ;Assessment of risk;Euroscore1-Age : for each 5 years over 60 years +1% 2-Female sex +1% 3-Chronic respiratory disease +1% 4-Extracardiac arteriopathy +2% 5-Neurological dysfunction +2% 6-Creatinine above 200 μmol/l +2% 7-Previous cardiac surgery +3% 8-Unstable angina +2% 9-Recent Myocardial infarction +2%10-Ejection fraction Good Nil Moderate +1% Poor +3% ;Choice of conduit;What are the other conduit options? ;;;Surgery;;;Right atrial cannulation to drain venous blood into venous reservoir by gravity .Oxygenation and CO2 removal usually by membrane oxygenator Air bubbles removal by A 40 mm filter. Heat exchanger Lowers blood temperature at 5-10 C of hypothermia Pump returns blood into aorta distal to the cross clamp Suction used to remove blood from operative field and returned to patient via cardiotomy reservoir ;Cardiac Transplantation;Congenital heart disease;;;Pathology;TOF with pulmonary Atresia (TOFPA) Variable pulmonary blood flow is present via a patent ductus arteriosus or aortopulmonary collaterals Hyoplastic remnants Of the Pulmonary artery branches ;;Clinical features;Investigation;;Management;;;Transposition of the great vessels;;;Cardiac Tumours;Aortic Coarctation;;;;ASD;;VSD;PDA;