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Slide 1 :
Cardiac Surgery By Paula Catterall Sister cardiac surgical intensive care unit.
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Anatomy and physiology of the Heart Lies within the chest cavity above the diaphram. Lies between the lungs. Within the mediastinum. Between the pleural layers. Extends from behind the sternum to the vertebral column, Lies 2/3rds to the left of the midline. Lies 1/3rd to the right of the midline. Size of clenched fist.
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Heart wall 3 layers Pericardium Myocardium Endocardium
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The Pericardium Confines the heart in position allowing sufficient freedom to fill and contract vigorously if required.
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The Myocardium Responsible for contraction of the heart. Constitutes the bulk of the heart. Made up of 3 muscle types.
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The Endocardium Lines the inside of the heart. Covers the valves and tendons that hold the valves. Continuous with the lining of the great vessels.
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Types of cardiac surgery Valve repair and replacement. Coronary artery bypass. Septal defects. Aneurysm repair. Trauma
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Aortic Valve surgery- Indications Dyspnoea Angina Aortic stenosis – pt’s with a history of reheumatic fever.
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Coronary Artery Surgery - Definition Coronary artery disease is a narrowing of the coronary arteries caused by atherosclerosis that, when sufficiently severe, limits the flow of blood to the myocardium. In it’s most severe form, it occludes the coronary arteries.
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What is Coronary Artery Surgery? One or more bypass grafts are implanted between the aorta and the coronary blood vessel. Occlusive vascular disease limits the blood flow to the heart. The bypass graft bridges the occluded or diseased heart blood vessel (coronary artery) and brings new blood to the heart. Veins from the patients legs or arteries like the internal mammary or radial artery are commonly used as grafts.
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Mitral Valve Surgery – Types Mechanical - Advantages – longer lasting Disadvantages – anticoagulation and thrombus formation. . Tissue Advantage – no anticoagulation needed Disadvantage – less durable need relpacing sooner.
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Mitral Valve Surgery - Repair Repairs to leaflets Repairs to ring Decalcification of the valve ADVANTAGES . Shorter operation . No anticoagulation . More successful longer term
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Post op care Haemodynamic stability – fluid resusitation, inotropic support, pacing and invasive heamodynamic monitoring. Respiratiory management – mechanical ventilation. Cardiac chest drains – bleeding. Renal function – adequate urine output.
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Post op care continued Length of stay 5-7 days. 24 hrs on cardiac intensive care unit. 24hrs on cardiac surgery high dependency unit. Rest of stay on cardiothoracic ward.
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Post operative complications Haemodynamic instability – cardiogenic shock, tamponade or bleeding. Unstable heart rhythm – requiring temporary or occasionally permanent pacing. Respiratory insufficiency – resp failure requiring long term weaning. Stroke Acute renal failure – requiring haemofiltration. Post op wound infections.
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Multidisciplinary team Cardio thoracic surgeons. Anaesthetist. Nursing staff. Physiotherapist. Cardiac liaison team. Dieticians. Occupational therapist.
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Mitral Valve SurgeryRepair. Repairs to leaflets; Repairs to ring; Decalcification of the valve. ADV
Mitral Valve SurgeryRepair. Repairs to leaflets; Repairs to ring; Decalcification of the valve. ADVANTAGES . Shorter operation . No anticoagulation …