外科学heart disease区景松.pdf

Heart Disease 区景松 教育部 特聘教授 国家杰出青年科学基金获得者 省珠江学者特聘教授 中山大学附属第一医院心脏外科 Contents Class 1 1.Basis of open heart surgery Cardiopulmonary Bypass and Myocardial Protection 2. Surgical treatment of congenital heart disease a. non-cyanosis heart disease b. Cyanosis heart disease (Tetralogy of Fallot) Class 2 Surgical treatment of acquired heart disease 1 Chronic constrictive pericarditis 2 Surgical treatment of heart valve disease ： Mitral stenosis et al. 4. Surgical treatment of coronary heart disease 5. Aortic disease 6. Cardiac myxoma 1. Basis of open heart surgery Cardiopulmonary Bypass and Myocardial Protection 体外循环和心肌保护 History of cardiac surgery 19th centuryopen heart surgery without CPB most patients died 1940s CPB technique Intracardiac construction visionable 1950s hypothermal technique End of 1950s CPB combined with hypothermia Nowadays almost all heart diseases can be Treated well Cardiopulmonary Bypass • Definition CPB for cardiac surgery is conceptually simple, and equipment is available to plish it with relative ease. Most or all of the patient’s systemic blood, which normally return to the right atrium ,is diverted into a device in which oxygen is d to the blood and carbon dioxide is removed. The newly arterialized blood is pumped from the device into the aorta. Elements of cardiopulmonary Bypass. 1. Pump Oxygenator Oxygenation of the blood. Elimination of Carbon dioxide. Ga change occuring the blood-gas interface. 2.Arterial pump Roller pump (nonpulsative flow) Centrifugal pump 3.Venous reservor Store cess volume Siphonage of blood by gravity 4.Heat exchanger Regulate the temperature Blood return