BEDAH

THORAXCARDIOVASKULER
dr. Fince Hulu
 PTCA
(Percutaneous Transluminal Coronary Angioplasty)
Anterior View
Posterior View
Gambaran EKG PJK
Contoh Endovaskuler
wire
Contoh Stent Ring
Coronary Artery Bypass Graft
Indikasi Bypass Surgery
Contoh Operasi
Bypass On Pump
Contoh Hasil
Bypass
Alat yang digunakan
pada operasi off
pump
Pacemaker
Mitral Valve Repair
Anatomi katup Jantung
Contoh katup yang mengeras
Vegetasi pada katup mitral oleh karena
infeksi bakteri (endocarditis)
 Penyakit Jantung Rematik

Tonsilitis

Eritema Marginatum

Subkutaneous Nodul
Contoh Penyebab
Kelainan Katup Mitral
Mitral Valve Disease – Echo findings
• Mitral Stenosis
– Thickened, deformed MV
leaflets
– 2D MVA
– Doppler Gradient
– Associated LAE, RVH, PHTN,
TR,MR, LV function
• Mitral Regurgitation
– Determine etiology – leaflets,
chordae, MVP, MI
– Doppler severity of MR jet
– LV function
Balloon Mitral Commissurotomy
Contoh Katup Buatan
Starr-Edwards aortic caged-ball valve

Bjork-Shiley
tilting-disc valve
 Medtronic-Hall
St. Jude bileaflet valve mechanical prosthesis
Katup bioprostesis
Diseksi Aorta
Klasifikasi Stanford pada Diseksi Aorta
Tanda Panah Menunjukkan Pelebaran
Aorta (pada marfan syndrom), Bila
dibiarkan akan robek (diseksi aorta)
3D CT-scan pada aneurisma aorta
sebagai penyebab diseksi aorta
Contoh Tindakan
Perbaikan Aorta
Deep Vein Trombosis
 Vascular Obstruction
Acute Arterial Obstruction Deep Vein Thrombosis (DVT)
• Skin is pale • Skin is red
• Pain increases with walking • Pain (tender, sore) with
and decreases with rest standing or dorsiflexion of
(intermittent claudication) foot
• No pulses • Pulses present
• Paresthesia • Sensation intact
• Paralysis • Able to move limb
 Risk Factors: Virchow’s Triad
• Stasis
• Venous endothelial injury
• Hypercoagulable state
 Virchow’s Triad

http://www.thrombosisadviser.com/en/understanding-thrombosis/how-thrombosis-develops/how-vte-occurs/index.php
 Risk Factors for DVT
* factors bolded have higher rates for development of DVT/PE
Risk Factor Risk Factor
Age< 40 Abdominal, Pelvic, Lower
Extremity Surgery
Age 40-60
Minor Surgery
Age > 60 (<30 min)
Major Surgery
Single Injury, (>30 min)
Non-orthopedic Cancer
Multiple Injury,
Previous Venous
Non-orthopedic
Thromboembolism
Orthopedic (VTE)
Injury Hypercoagulable States
 Risk Factors (cont’d)
Risk Factor Risk Factor
Obesity Inflammatory Bowel
(Above 120% IBW) Disease
Expected Immobility Nephrotic Syndrome
(>48 hours)
Pregnant/Puerperium
Thrombotic Stroke/
Paralysis Hormone Replacement
Recent MI or Varicose veins
Heart Failure
Indwelling Central Smoking
Venous Catheter
 Brown
pigmentation

Venous
eczema
Venous
Ulcer
Lipodermatosclerosis

Venous Ulcer
Venogram Iliac vein Thrombosis
Contoh pemeriksaan Dopler DVT
Burger Disease
 (Fontaine’s classification)
Pain at rest

Feeling of coldness,
Numbness

Intermittent claudication
Ulceration, Necrosis
 Risk Factor Modification

Risk Factors of PAD

* Hypertension * Smoking
* Hyperlipidemia * Obesity
* Diabetes mellitus * Lack of exercise
* Stress * Being older than age 50

• Most people with PAD can be treated with lifestyle changes,

medications or both. Lifestyle changes include:
–Stop smoking (smokers have a particularly strong risk of PAD).
–Control diabetes.
–Control blood pressure.
–Be physically active (including a supervised exercise program).
–Eat a low-saturated-fat, low-cholesterol diet.
Contoh Oklusi Artery Femoral Pada Perokok
Berat dan Claudicatio Intermitten
(Menggunakan angiografi)
Screening PAD
Efusi Pleura
 Gejala Klinis
I. Symptoms: mainly dictated by underlying process, may
have no symptom to severe illness.
- pleuritic chest pain
- dullness
- non productive cough
- dyspnea

II. Physical examination:

- inspection: sizes of the hemithoraces and the
intercostal space
- palpation
- percussion
- auscultation: decreased or absent breath sounds,
pleural rubs
MADE IN ENGLAND

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SAOHAGOLO