overview on cardioplegia by Dr. Idit Avrahami


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  • When the atrtiums are compressed and the ventricles are filled with blood it is called diastoly and when the ventricles are compressed and flow is pushe away, it is called systole.
  • After the operation, the patient will spend 7 to 10 days in the hospital, the first 1 to 3 days in an intensive-care unit (ICU). Chest tubes will be in place for the first 2 to 3 days to drain any residual blood and fluid from around the heart. Heart functions will be monitored. The full benefits from the operation may not be ascertained until 3 to 6 months after surgery. Sexual activity may be resumed 3 to 4 weeks after surgery. All activities that do not cause fatigue are permitted, but the patient must not strain the healing chest bone (sternum).
  • overview on cardioplegia by Dr. Idit Avrahami

    1. 1. Diastole Systole
    2. 2. Cardiac Disease <ul><li>Heart failure and Ischemia </li></ul><ul><li>Valvular heart disease </li></ul><ul><li>Congestive Heart Failure (CHF) </li></ul><ul><li>Aortic failure </li></ul><ul><li>Congenital heart disease (CHD) </li></ul>
    3. 3. The Coronary Circulation
    4. 4. Coronary Origin (LM) (LM) (LAD) (RCA) (Circ)
    5. 5. Atherogenesis
    6. 7. Balloon Angioplasty
    7. 8. Stent NIR® stent Medinol Ltd.
    8. 9. Balloon Expended Stent
    9. 10. Self Expanded Stent
    10. 11. Main Problem with Angioplasty: =>In Stent Restenosis
    11. 12. Restenosis
    12. 13. Drug Eluting Stents (DES) <ul><li>Cumulative risk of restenosis </li></ul>BMS DES DES: cons and pros: http://www.clalit.org.il/HE-IL/General/heart/prevent/articles/stent.htm
    13. 14. Another Problem : =>Vulnerable Plaque
    14. 15. THE PATHOGENESIS OF ATHEROSCLEROSIS Schematic longitudinal section of an artery showing different stages of atherosclerotic plaque vulnerability: A, Normal; B, Rupture-prone plaque; C, Plaque rupture with fissure; D, Critical stenosis; E, Erosion-prone plaque; F, Intra-plaque hemorrhage.
    15. 17. =>Total Occlusion
    16. 18. Total Occlusion
    17. 19. Anatomy of the Heart <ul><li>Heart chambers: </li></ul><ul><ul><li>Left & right atria. </li></ul></ul><ul><ul><li>Left & right ventricles. </li></ul></ul><ul><li>Heart valves: </li></ul><ul><ul><li>Atrioventricular valves: </li></ul></ul><ul><ul><ul><li>Right: Tricuspid. </li></ul></ul></ul><ul><ul><ul><li>Left: Bicuspid/Mitral </li></ul></ul></ul><ul><ul><li>Semilunar valves </li></ul></ul><ul><ul><ul><li>Right: Pulmonary valve. </li></ul></ul></ul><ul><ul><ul><li>Left: Aortic valve. </li></ul></ul></ul>
    18. 20. The Heart Valves Left ventricle Right ventricle
    19. 21. Valvular stenosis a narrowing, stiffening, thickening, fusion or blockage of one or more valves Valvular regurgitation blood leakage back in the wrong direction because improperly valve’s closure Valve prolapsed Valvular Heart Cardiac Disease http://www.heartlibrary.com/heart-library-heart-valve-repair-replacement.aspx
    20. 22. Aortic Valve Stenosis
    21. 24. Aortic valve - 63% Mitral valve – 14%
    22. 25. Heart Valve Repair
    23. 26. טכנולוגיות רפואיות : כירורגית לב <ul><li>טיפול כירורגי באי - ספיקת לב  </li></ul><ul><li>טיפול כירורגי בהפרעות קצב  </li></ul><ul><li>ניתוח מעקפים כליליים </li></ul><ul><li>תיקון והחלפת מסתמים </li></ul><ul><li>תיקון מומים מולדים בילדים  </li></ul>
    24. 27. Heart-Lung Machine Cardiopulmonary bypass (CPB) Schematic Explanation: http://www.youtube.com/watch?v=RlRi3R9LXng In vivo use: http://www.youtube.com/watch?v=tGgs2zm6HFU&NR=1 CPB (the machine) : http:// www.youtube.com/watch?v = dNHcJQFPrDk
    25. 29. Oxygenator (Heart-Lung machine)
    26. 32. <ul><li>Cardioplegia Cannula in ascending aorta. </li></ul><ul><li>Cross-clamp on ascending aorta. </li></ul><ul><li>Cross-clamp on main pulmonary artery. </li></ul><ul><li>Arterial bypass cannula in the main pulmonary artery. </li></ul><ul><li>Cardioplegia catheter in the main pulmonary artery. </li></ul><ul><li>Dilated conal branch of the right coronary artery. </li></ul><ul><li>Venous bypass cannula in the right atrial appendage. </li></ul><ul><li>Left heart vent. </li></ul>
    27. 34. Aortic Perfusion Cannula
    28. 35. http://www.terumo-cvsmedia.com/flash.php?nm=sarns_soft_flow
    29. 36. Venous Return Single stage Dual stage
    30. 37. Retrograde Catheters
    31. 38. Femoral Cannulae
    32. 39. תסחיפים ובועיות בדם <ul><li>http://www.e-med.co.il/emed/new/UserSite/content.asp?CatID=26&ContentID=214293&dacc=1 </li></ul>
    33. 40. Coronary Artery Bypass Graft (CABG) <ul><li>blood flow is rerouted through a new artery or vein that is grafted around diseased sections of the coronary arteries to increase blood flow to the heart muscle tissue. </li></ul>http://www.youtube.com/watch?v=RZhPZc1Uhws
    34. 43. Prosthetic Heart Valves
    35. 44. Heart Valve Replacement http://www.fda.gov/hearthealth/flash/fda_26.html
    36. 45. Prosthetic Heart Valves (PHV) <ul><li>Bio-Prosthetic Valves Porcine Xenografts </li></ul><ul><li>Mechanical Heart Valves (MHV) </li></ul>
    37. 46. Heart Valve Replacement
    38. 47. Heart Valve Replacement http://www.youtube.com/watch?v=o6xS3sYSAl8 http://il.youtube.com/watch?v=G95lk41TmsU Bioprosthetic (solo) http://www.e-med.co.il/emed/new/usersite/presentations/bepex/bepex_solo.html
    39. 48. Actual Geometry after valve implantation
    40. 50. Tilting Disk MHV (Bjork-Shiley) Bileaflet MHV (St.Jude) Caged Ball MHV
    41. 53. Flexible Valves Tri-leaflet silastic reinforced leaflets Bioprosthetic (tissue) Valve
    42. 54. Minimally invasive valve treatment <ul><li>Minimally invasive mitral valve surgery (MIMVS) does not </li></ul><ul><li>refer to a single approach but rather to a collection of </li></ul><ul><li>new techniques and operation-specific technologies. </li></ul>Mitral Valve Repare: http://www.e-med.co.il/emed/new/Usersite/Presentations/Cardio1109b/Raanani_P_files/Default.htm#nopreload=1 slide 12
    43. 55. Additional Movies <ul><li>בנושא משאבת לב ריאה : </li></ul><ul><li>Schematic Explanation: http:// www.youtube.com/watch?v =RlRi3R9LXng </li></ul><ul><li>In vivo use: http:// www.youtube.com/watch?v =tGgs2zm6HFU&NR=1 </li></ul><ul><li>CPB (the machine) : http:// www.youtube.com/watch?v = dNHcJQFPrDk </li></ul><ul><li>בנושא החלפת מסתם : </li></ul><ul><li>http://www.heartlibrary.com/heart-library-heart-valve-repair-replacement.aspx </li></ul><ul><li>http://www.youtube.com/watch?v=o6xS3sYSAl8 </li></ul><ul><li>http://il.youtube.com/watch?v=G95lk41TmsU </li></ul><ul><li>לגבי סוג המסתם ( מכני או ביולוגי ): </li></ul><ul><li>http://www.e-med.co.il/emed/new/usersite/content.asp?CatID=1&ContentID=210695 </li></ul><ul><li>בנושא ניתוחי מעקפים : </li></ul><ul><li>http:// www.youtube.com/watch?v =RZhPZc1Uhws </li></ul><ul><li>http://www.israel-heart.org.il/intervention/oscar07.asp </li></ul>