CARDIOLOGY

Introduction ,
Cardiorespiratory
Resuscitation
PRESENTED BY ; MISS UROOJ TAJ JADOON

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 INTRODUCTION TO CARDIAC
SURGERY
In 1925 Sir Henry Souttar reported the first mitral
commissurotomy in the British Medical Journal.
 He wrote that the heart should be as amenable to surgery as
any other organ.
 He saw the main problem as being maintenance of blood flow,
particularly to the brain, while surgery was being performed.

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The first real advances occurred in the late 1940s and early
1950s, driven by surgeons who had gained confidence and
experience under the pressures and opportunities provided
by war, followed by the development of cardiopulmonary
bypass in the mid-1950s.

Recently, the well-being and lifespan of patients with

congenital, valvular and degenerative heart disease has
improved drastically due to the advances in the range,
complexity and technical expertise in cardiac surgery
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CARDIORESPIRATORY
RESUSCITATION
Cardiopulmonary resuscitation (CPR) is a lifesaving technique that's useful in many
emergencies in which someone's breathing or heartbeat has stopped.

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Resuscitation Indications
◦ In children and younger adults, CPR is required
most commonly for
◦ respiratory arrest,
◦ airway obstruction or drug overdose.
◦ Major trauma, external or internal haemorrhage,
◦ major pulmonary embolism,
◦ profound anaphylaxis,
◦ critical cerebrovascular event may call for
resuscitation at any age.

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AFTER SURGERY
Cardiac arrest [0.7-2.9%]

Ventricular Major
Temponade
fibrillation bleeding

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MANAGEMENT OF CARDIAC
ARREST AFTER CARDIAC
SURGERY
. The incidence of cardiac arrest after cardiac surgery is
around 0.7–2.9%, with 17–79% survival rates. Ventricular
fibrillation (VF), tamponade and major bleeding account for
most arrests
 Multiple variables may dictate differences in the
management of cardiac arrest after cardiac surgery when
compared to other situations.
 Therefore, EACTS published guidelines for resuscitation of
cardiac arrest post cardiac surgery

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Cardiac arrest with non shockable
rhythm
Cardiac patients have ventricular tachycardia arrests with no
pulse
May have tamponade , tension pneumothorax or severe
hypovolemia
If pacemaker and atropine fails to save the patient treatment
would be RESTERNOTOMY
We defined RS as a repeat sternotomy performed at least one
month following the prior sternotomy and requiring a saw to
reopen the full length of the sternum
Emergency resternotomy is an integral part of an established
protocol for resuscitation of patients who arrest after cardiac
surgery

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EMERGENCY RESTERNOTOMY
After the identification of cardiac arrest, basic life support
according to the Advanced Life Support (ALS) guidelines
should be initiated while preparing for emergency
resternotomy.
Emergency resternotomy may be required in 0.8–2.7% of
all patients undergoing cardiac surgery
. Emergency resternotomy is a multipractitioner
procedure, which should be rapidly performed with full
aseptic technique
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Suction any clot
Spreader just beneath sternum
remove clot and identify the position of any grafts
Internal cardiac massage—
two handed (gentle even pressure)

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The retractor is placed between the sternal edges and the
sternum opened.
 If cardiac output is restored expert assistance should then
be summoned.
If there is no cardiac output, the position of any grafts
should be carefully identified and internal cardiac massage
and internal defibrillation performed, if required.

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 Internal cardiac massage
TWO-HAND TECHNIQUE

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Special Investigation Procedures In
Cardiac Surgery
MADE BY
UMAMA WAHEED
Chest X-ray Criteria for the Diagnosis Of Cardiomegaly in
Adults

The size of the heart is compared with the diameter of the chest; the
ratio should be no more than 50%.
Cardiac Surgery
Techniques
KHUZAIFA
ROLL NO 30
Cardiac surgery involves various techniques depending on the specific
procedure. Common techniques include
Coronary Artery Bypass Grafting (CABG)
Valve Repair or Replacement
Heart Transplant
Minimally Invasive Approaches
Angioplasty
Aneurysm Repair
1-Coronary Artery Bypass Grafting
(CABG)
Coronary artery bypass grafting (CABG), also called heart bypass surgery, is a
medical procedure to improve blood flow to the heart. It may be needed when
the arteries supplying blood to the heart, called coronary arteries, are narrowed
or blocked
On-pump CABG: The heart is temporarily stopped, and a heart-lung machine
takes over the function of pumping blood and oxygenating it.
Off-pump CABG: The surgery is performed on a beating heart without the use of
a heart-lung machine.
 procedure
Graft Harvesting: Typically, a blood vessel (often the saphenous vein from the leg or internal mammary
artery from the chest) is harvested to use as a graft.

Circulation Bypass: The patient is connected to a heart-lung machine, which temporarily takes over the
function of the heart and lungs.

Graft Placement: The graft is then used to create a bypass around the blocked or narrowed coronary
arteries, restoring blood flow to the heart.

Heart-Lung Machine Removal: Once the grafts are in place, the heart-lung machine is disconnected, and
the heart resumes its normal function.
2-Valve Repair or Replacement
Valve repair and replacement are two approaches in treating heart valve disorders.
Valve Repair:
Objective: Preserve the patient's own valve and correct abnormalities.
Techniques: Various methods, such as reshaping, resizing, or rejoining valve components.
Advantages: Potential for better preservation of natural valve function and avoidance of lifelong
anticoagulation in some cases.
Commonly Used for: Mitral valve repair is frequently performed
Valve Replacement:
Objective: Substitute a damaged or diseased valve with a prosthetic valve.
Types of Replacement Valves:
Mechanical Valves:[made up of carbon coated plastic] Durable but require
lifelong anticoagulation to prevent blood clot formation.
Biological Valves:[made from animal valve or from human valve taken from
doner]Mimic natural valves, may not require lifelong anticoagulation, but have a
limited lifespan.
Indications: Used when the valve damage is severe, and repair isn't feasible
3-Aneurysm Repair:
Aneurysm repair is a surgical procedure aimed at addressing weakened or bulging areas in the
body's blood vessels, commonly performed in the aorta
Purpose: Correcting weakened, bulging sections (aneurysms) to prevent rupture.
Types:
Open Repair: Involves a traditional surgical approach, requiring a large incision to replace the
weakened segment with a synthetic graft[made of decron ,a form of polyester].
Endovascular Aneurysm Repair (EVAR): Minimally invasive, using catheters and stents to
reinforce the weakened vessel without a major incision.
Indications: Typically performed for abdominal or thoracic aortic aneurysms.
Open Repair:
Surgeon makes an incision, clamps the aorta, removes the weakened section, and
replaces it with a synthetic graft.
Endovascular Aneurysm Repair (EVAR):
Catheters are threaded through blood vessels, and a stent-graft is placed at the site of
the aneurysm to reinforce the vessel.
Considerations:

Choice between open repair and EVAR

depends on factors like aneurysm size,
location, and patient's overall health.
EVAR is less invasive, often resulting in quicker
recovery compared to open repair.
4-Minimally Invasive Surgery (MIS)
Minimally Invasive Surgery (MIS) in cardiac procedures involves performing surgeries through small
incisions, as opposed to traditional open-heart surgery
Characteristics of Minimally Invasive Cardiac Surgery:
Smaller Incisions:
Purpose: To minimize trauma to the chest and reduce scarring.
Benefits: Generally leads to quicker recovery times and potentially less postoperative pain.
Endoscopic Techniques:
Procedure: Utilizes specialized instruments and cameras inserted through small incisions or ports.
Examples: Minimally invasive coronary artery bypass grafting (MICS CABG) and minimally invasive
mitral valve repair or replacement.
Robotic-Assisted Surgery:
Procedure: Surgeons use robotic systems to perform precise movements through console
controls.
Advantages: Enhanced dexterity and visualization for intricate procedures.
Thoracoscopic Approaches:
Procedure: Involves accessing the heart through the chest wall, avoiding a sternotomy
(traditional chest incision).
Benefits: Reduced risk of infection and potentially faster recovery.
Indications:
Minimally invasive techniques may be suitable for selected patients with conditions such as
coronary artery disease, mitral valve disease, and atrial septal defects.
Considerations:
Not all cardiac procedures can be performed using minimally invasive techniques, and the
choice depends on the specific diagnosis and patient factors.
Advances in technology and surgical expertise continue to expand the range of procedures that
can be done minimally invasively.
Reference
https://intermountainhealthcare.org/services/heart-care/treatment-and-detection-methods/car
diothoracic-surgery/
BOOK; CLINICAL SURGERY
THANKS