dental management patients with cardiovascular disorders.pptx
clinical meeting 19.12.13
1. 1ST ANNUAL CLINICAL MEETING
DIVISION OF CARDIAC SURGERY
Shisong Cardiac Center
Organizing Committee: Mr. Marcel Fanka Tanlanka
Program
(5 minutes for each presentation)
Moderators: Dr. Jacques Cabral Tantchou Tchoumi; Dr. Jean Claude Ambassa
The Role of Extracorporeal Circulation in Cadiac Surgery
Mr. Fanka Tanlanka Marcel ; Discussants: Sr. Juliet Berinyuy; Hilary Ayong
Surgical Techniques for the Establishment of Extracorporeal Circulation
Mr. Julius Peter Mbiydzenyuy ; Discussant: Mr. Roger Tachea
The Use of Inotropes in Cardiac Surgery
Mr. Thierry Yunishe ; Discussant: Sr. Ruth; Mr. Gerard
Management of Cardiac Arrythmias after Open-Heart Surgery
Mr. Justin Bika; Discussant: Sr. Isodora
One -Year Experience in Cardiac Surgery at The Shisong Cardiac Center
Dr. Charles Mve Mvondo ; Discussants: Dr. Jean Claude Ambassa, Dr Jacques Cabral Tantchou Tchoumi
Open Discussion and Cardiologists Point of View
Conclusions
Dr. Charles Mve Mvondo
Thursday 19, December 2013; 07.30 to 8.30 am; Relax Area, ICU. Cardiac Center.
2. The Role of EThe Role of E xtraxtraCCorporealorporeal
CCirculation in Cardiacirculation in Cardiac
SurgerySurgery
Presentation: Fanka Tanlaka MarcelPresentation: Fanka Tanlaka Marcel
• Discussant : Sr Juliette BerinyuyDiscussant : Sr Juliette Berinyuy
• Contributions : Ayong Hilary GahContributions : Ayong Hilary Gah
3. What is Extracorporeal
Circulation ?
A medical equipment that provides
Cardiopulmonary bypass, (temporary
mechanical circulatory support) to the
stationary heart and lungs)
• Heart and Lungs are made “functionless
temporarily” , in order to perform surgeries
5. What key things does ECC do
during Cardiac Surgery ?
• Provides bloodless field for the Surgeon
• Artificial Pump
• Artificial lungs
• Myocardial protection
• Organs function
• Blood gas, chemistry , anticoagulation
state
6. “to return the patient to the normal
physiologic state in spite of the
insults that may transpire’’
Goal of the Perfusionist
10. Surgical Techniques for the
Establishment of
Extracorporeal Circulation
Mr. Julius Peter Mbiydzenyuy ;
Discussant: Mr. Roger Tachea
11. Introduction
• Most operations require the use of CPB.
• Basic techniques of arterial and venous
cannulation are similar in both CHD &
adult cardiac surgery.
• Some modifications are necessary to
accommodate the multiple anatomical
variations that may be encountered in
congenital defects
13. The procedure
• Collection of Cannulae
• Reception and fixation of CPB Circuit
to the Sterile camp
• Standard median sternotomy or
Thoracotomy
• Purse Strings
• Cannulation
18. Conclusion
The techniques which are described
in this presentation are used
routinely in our institution in all
patients, whatever the complexity
of the pathologies and the age of
the patients.
20. The Use of Inotropes in
Cardiac Surgery
Mr. Thierry Yunishe ;
Discussant: Sr. Ruth GOOH; Mr.
Gerard Kindzeka
21. The use of Inotropes in
Cardiac Surgery
• Drugs that affect the
force of contraction
of myocardial
muscle
• Positive or negative
• Term “inotrope”
generally used to
describe positive
effect
29. Main classes of Adrenoceptor
∀α receptors
α1
• Located in vascular smooth muscle
• Mediate vasoconstriction
α2
• Located throughout the CNS, platelets
• Mediate sedation, analgesia & platelet
aggregation
30. Main classes of Adrenoceptor
∀β receptors
β1
• Located in the heart
• Mediate increased contractility & HR
β2
• Located mainly in the smooth muscle of bronchi
• Mediate bronchodilatation
• Located in blood vessels
– Dilatation of coronary vessels
– Dilatation of arteries supplying skeletal muscle
31. Epinephrine (Adrenaline)
• Stimulates α & β receptors
– Predominantly β effects at low doses and α effects at high
doses
• Clinical uses
– Cardiac arrest
– Anaphylaxis
– Low cardiac output states
– Upper airway obstruction
– Combination with local anaesthetics
• Side effects
– Dysrhythmias
– Increase in myocardial oxygen consumption
32. Norepinephrine
• Predominantly stimulates α1 receptors
• Most commonly used vasopressor in
critical care
• Very potent
• Administered by infusion into a central
vein
• Uses
– Hypotension due to vasodilatation
– Septic shock
37. • SA Node
• Inter-nodal and
inter-atrial pathways
• A-V Node
• Bundle of His
• Perkinje Fibers
Conduction System
38. • Normal
– Heart rate = 60 – 100 bpm
– PR interval = 0.12 – 0.20 sec
– QRS interval <0.12
– SA Node discharge = 60 – 100 / min
– AV Node discharge = 40 – 60 min
– Ventricular Tissue discharge = 20 – 40 min
Physiology
39. • Cardiac cycle
– P wave = atrial depolarization
– PR interval = pause between atrial and
ventricular depolarization
– QRS = ventricular depolarization
– T wave = ventricular depolarization
Physiology
40. Arrhythmias
• Definition: Heart rhythm problems
(arrhythmias) occur when the electrical
impulses in your heart that coordinates
your heartbeats don't function properly,
causing your heart to beat too fast, too
slow or irregularly.
41. Arrhythmias
● Arrhythmias may cause sudden death, syncope,
heart failure, dizziness, palpitations or no
symptoms at all.
● There are two main types of arrhythmia:
bradycardia: the heart rate is slow (< 60 b.p.m).
tachycardia: the heart rate is fast (> 100 b.p.m).
42. Pathophysiology of Arrhythmias.
• Arrhythmias:- Heart is beating too fast,
- Heart is beating too slow,
- Heart is beating irregularly.
• Two types of arrhythmias; Bradycardia & Tachycardia
• Bradycardia; Heart is beating too slow.
Two causes: 1) SA node is either slowed or absent.
2) Blockage of conduction at the AV node
3) types of Heart blocks)
• Tachycardia; Heart is beating too fast,
Causes: 1) Increased Pace maker Activity from the SA node
2) Re-entry Tachycardia
3) Delayed Repolarization
45. One -Year Experience in
Cardiac Surgery at The
Shisong Cardiac Center
Dr. Charles Mve Mvondo ;
Discussants: Dr. Jean Claude
Ambassa, Dr Jacques Cabral
Tantchou Tchoumi
47. Conclusion
“CARDIAC SURGERY CAN BE SIMPLY AWEFULLY
CARDIAC SURGERY CAN BE AWEFULLY SIMPLY”
Thank you so much. Happy Christmas & prosperous New Year 2014
