cardiothoracic surgeries

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Cardiothoracic Surgeries Presented by Mrs. Carrole Earnest 3/31/2011 1 cardiothoracic surgeries

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Cardiac surgeries 3/31/2011 2 cardiothoracic surgeries

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Percutaneous coronary interventions Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist 3/31/2011 3 cardiothoracic surgeries


PTCA Percutaneous Transluminal Coronary Angioplasty 3/31/2011 cardiothoracic surgeries 4

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Percutaneous transluminal coronary angioplasty (PTCA) is performed to open blocked coronary arteries caused by coronary artery disease (CAD) and to restore arterial blood flow to the heart tissue without open-heart surgery. A special catheter (long hollow tube) is inserted into the coronary artery to be treated. This catheter has a tiny balloon at its tip. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow. The use of fluoroscopy (a special type of x-ray, similar to an x-ray) assists the physician in the location of blockages in the coronary arteries as the contrast dye moves through the arteries. A small sample of heart tissue (called a biopsy) may be obtained during the procedure to be examined later under the microscope for abnormalities. 3/31/2011 5 cardiothoracic surgeries

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3/31/2011 6 cardiothoracic surgeries

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Coronary Artery Stent A coronary stent is stainless tube with slots. It is mounted on a balloon catheter in a "crimped" or collapsed state. When the balloon of is inflated, the stent expands or opens up and pushes itself against the inner wall of the coronary artery. This holds the artery open when the balloon is deflated and removed. 3/31/2011 7 cardiothoracic surgeries

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3/31/2011 8 cardiothoracic surgeries

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3/31/2011 9 cardiothoracic surgeries

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Atherectomy An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. The catheter is inserted into the artery through a small puncture in the artery, and it is performed under local anaesthesia. The catheter is designed to collect the removed plaque in a chamber in the tip, which allows removal of the plaque as the device is removed from the artery. The process can be repeated at the time the treatment is performed to remove a significant amount of disease from the artery, thus eliminating a blockage from atherosclerotic disease. 3/31/2011 10 cardiothoracic surgeries

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3/31/2011 11 cardiothoracic surgeries

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Brachytherapy It involves the delivery of gamma or beta radiation by passing a radioisotope close to the lesion. The radioisotope may be delivered by a catheter or implanted with the stent. Brachytherapy reduces the recurrence of obstruction, preventing vessel restenosis by inhibiting smooth muscle cell proliferation. 3/31/2011 12 cardiothoracic surgeries

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Coronary Artery Revascularization CABG: Coronary Artery Bypass Graft Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. Indications of CABG:- Chronic angina Unstable angina Acute myocardial infarction Acute failure of percutaneous transluminal coronary angioplasty (PTCA) Severe coronary artery disease 3/31/2011 13 cardiothoracic surgeries

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Vessels commonly used for CABG Veins: Greater saphenous vein Lesser saphenous vein Cephalic vein Basilic vein Arteries: Right and left internal mammary arteries Radial arteries 3/31/2011 14 cardiothoracic surgeries

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Procedure: The cardiac surgeon makes an incision down the middle of the chest and then saws through the breastbone (sternum). This procedure is called a median (middle) sternotomy (cutting of the sternum). The heart is cooled with iced salt water, while a preservative solution is injected into the heart arteries. This process minimizes damage caused by reduced blood flow during surgery and is referred to as "cardioplegia." Before bypass surgery can take place, a cardiopulmonary bypass must be established. Plastic tubes are placed in the right atrium to channel venous blood out of the body for passage through a plastic sheeting (membrane oxygenator) in the heart lung machine. The oxygenated blood is then returned to the body. The main aorta is clamped off (cross clamped) during CABG surgery to maintain a bloodless field and to allow bypasses to be connected to the aorta. 3/31/2011 15 cardiothoracic surgeries

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Then an incision is made in the target coronary artery and is anastomosed with the graft. CABG surgery takes about four hours to complete. The aorta is clamped off for about 60 minutes and the body is supported by cardiopulmonary bypass for about 90 minutes. At the end of surgery, the sternum is wired together with stainless steel and the chest incision is sewn closed. Plastic tubes (chest tubes) are left in place to allow drainage of any remaining blood from the space around the heart (mediastinum). 3/31/2011 16 cardiothoracic surgeries

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3/31/2011 17 cardiothoracic surgeries

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Valvuloplasty: Valvuloplasty is a procedure in which a small balloon is inserted and inflated to stretch and open a narrowed (stenosed) heart valve. Pocedure : Valvuloplasty is performed in Cardiac Catheterization laboratory or cath . lab. The procedure of Valvuloplasty may take up to four hours. A local anaesthetic is injected in the groin at the site where the catheter will be inserted. Guided by a fluoroscopy and x-rays, the cardiologist carefully inserts and threads a catheter through the artery or vein depending on where the problem lies. Once this catheter is in place, a balloon tipped catheter is slowly threaded through the first catheter; the deflated balloon is repeatedly inflated to open the valve leaflets apart. Once the valvular opening has been widened enough, the balloon tipped catheter is removed while the first catheter is left in place in case the procedure needs to be repeated. 3/31/2011 18 cardiothoracic surgeries

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3/31/2011 19 cardiothoracic surgeries

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Heart valve surgery: Heart valve surgery is used to repair or replace diseased heart valves. Procedure: A mitral valve replacement procedure is performed under general anaesthesia, which will keep the patient asleep during the whole surgery. The preferred method is to first make an incision under the left breast. After the heart is exposed, blood must be rerouted to a heart-lung machine (cardiopulmonary bypass). An incision is made in the left atrium to expose the mitral valve. The valve is then replaced with either a biological or mechanical valve. Then after the functioning of the new valve is tested and confirmed, the heart is then closed with sutures. The patient is then taken off the cardiopulmonary bypass and blood is allowed to flow into the coronary arteries. If the heart does not beat on its own, an electric shock is used to start it. Then the chest is closed up 3/31/2011 20 cardiothoracic surgeries

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3/31/2011 21 cardiothoracic surgeries

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Nursing Management: Preoperative nursing diagnosis: Ineffective cardiac tissue perfusion related to reduced coronary blood flow Fear r/t the surgical procedure Deficient knowledge regarding the surgical procedure and the post operative course Postoperative nursing diagnosis: Decreased cardiac output r/t blood loss, compromised myocardial function and dysrrhythmias Impaired gas exchange r/t the trauma of chest surgery Risk for imbalanced fluid volume r/t alteration in circulating blood volume Acute pain r/t surgical trauma and pleural irritation caused by chest tubes Ineffective tissue perfusion r/t decreased cardiac output…… Deficient knowledge about self care activities 3/31/2011 22 cardiothoracic surgeries

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Thoracic Surgeries 3/31/2011 23 cardiothoracic surgeries

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Pneumonectomy A pneumonectomy is the surgical removal of a lung and done so through a thoracotomy. Procedure: The surgeon makes an incision in the chest while the patient is under general anaesthesia. Part of the rib may then be removed to allow for adequate working space for the doctor. The lung is then collapsed and blood vessels are tied off. The diseased lung's air tube is then clamped and cut. The lung is then removed through the incision. The physician will then check to see if the air tube is leaking air, and then the incision is closed with staples or stitches. 3/31/2011 24 cardiothoracic surgeries

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Complications of pneumonectomy Minor pneumonectomy complications can include: Nausea and vomiting Minor infections Minor bleeding or bruising Abnormal or painful scar formation Allergic skin reaction to tape, dressings, or latex Skin numbness. Major complications include: A bronchopleural fistula An irregular heart rhythm Inability to breathe without a ventilator Persistent shortness of breath. 3/31/2011 25 cardiothoracic surgeries

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Some of the other major problems that can happen are: Lung problems, such as partial or complete lung collapse or lung failure Heart problems, such as heart attack or heart failure Serious infection Significant bleeding Stroke Blood clots Wound breakdown Reaction to medication or anaesthesia Nerve injury Blood vessel injury Loss of life Other rare and unlikely events . 3/31/2011 26 cardiothoracic surgeries

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3/31/2011 27 cardiothoracic surgeries

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Lobectomy A lobectomy is the surgical removal of a large section of lung. Lobectomy is the most common surgery performed to treat lung cancer. Procedure: An incision is made in the lateral aspect of the chest, and ribs may be removed or spread apart to allow the surgeon access to the lung . The main arteries, veins, and air tubes (bronchi ) are clamped, severed and ligated and the lobe is removed. A drainage tube is then inserted in the chest and the surgical wound is closed. The drainage tube drains any fluids that may build up in the chest and maintains the negative pressure necessary for inflation of the lung. 3/31/2011 28 cardiothoracic surgeries

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3/31/2011 29 cardiothoracic surgeries

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Segmentectomy A lung segmentectomy is the removal of a portion of the lung. Procedure: T he surgeon removes a small section of the lung (including the tumour and layers of tissue that line the air passages) through an incision made between the ribs in the chest. Lymph nodes may also be taken out during the operation. 3/31/2011 30 cardiothoracic surgeries

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3/31/2011 31 cardiothoracic surgeries

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Wedge resection of the lungs Wedge resection of the lung is a surgical operation where a part of a lung is removed. It is done to remove a localized portion of diseased lung, such as early stage lung cancer. Procedure: Lung resection is performed under general anaesthesia. To perform a lung resection, the surgeon makes an incision in the chest. If necessary, a rib is removed from the chest to gain better access to the diseased part of the lung. The lung is examined and the area of concern, such as a tumour, is identified. The blood vessels that supply the area to be removed are sutured, or tied off, and cut. The tumour or diseased area is then removed. If cancerous tumours are removed, the lymph nodes near the lung and draining the lung are also removed. After removal of the diseased area, the muscles are sutured and reconstructed. A chest tube is left in place to remove fluid, blood, and air from the lung and chest wall. The incision is closed with sutures, clips, or staples. 3/31/2011 32 cardiothoracic surgeries

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Lung volume reduction surgery Lung volume reduction surgery (LVRS) is a procedure which removes approximately 20-35% of the poorly functioning, space occupying lung tissue from each lung. By reducing the lung size, the remaining lung and surrounding muscles (intercostals and diaphragm) are able to work more efficiently. This makes breathing easier and helps patients achieve greater quality of life. 3/31/2011 33 cardiothoracic surgeries

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Nursing management of patient undergoing thoracic surgeries 3/31/2011 34 cardiothoracic surgeries

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Thank You 3/31/2011 35 cardiothoracic surgeries