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1ST ANNUAL CLINICAL MEETING DIVISION OF CARDIAC SURGERYShisong Cardiac CenterOrganizing 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 SurgeryMr. Fanka Tanlanka Marcel ; Discussants: Sr. Juliet Berinyuy; Hilary Ayong
Surgical Techniques for the Establishment of Extracorporeal CirculationMr. Julius Peter Mbiydzenyuy ; Discussant: Mr. Roger Tachea
The Use of Inotropes in Cardiac SurgeryMr. Thierry Yunishe ; Discussant: Sr. Ruth; Mr. Gerard
Management of Cardiac Arrythmias after Open-Heart SurgeryMr. Justin Bika; Discussant: Sr. Isodora
One -Year Experience in Cardiac Surgery at The Shisong Cardiac CenterDr. Charles Mve Mvondo ; Discussants: Dr. Jean Claude Ambassa, Dr Jacques Cabral Tantchou Tchoumi
Open Discussion and Cardiologists Point of View
ConclusionsDr. Charles Mve Mvondo
Thursday 19, December 2013; 07.30 to 8.30 am; Relax Area, ICU. Cardiac Center.
The Role of EThe Role of ExtraxtraCCorporeal orporeal CCirculation in Cardiac Surgeryirculation in Cardiac Surgery
Presentation: Fanka Tanlaka MarcelPresentation: Fanka Tanlaka Marcel• Discussant : Sr Juliette BerinyuyDiscussant : Sr Juliette Berinyuy• Contributions : Ayong Hilary GahContributions : Ayong Hilary Gah
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
The Physiology of ECC
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
“to return the patient to the normal
physiologic state in spite of the insults that may transpire’’
Goal of the Perfusionist
Factors Inspiring Evolution• Coagulation Disorders• Biocompatibility• Infection Control• Blood transfusion• Haemolysis• Biochemistry & BGA• Post operative complications
Future Prospects1. Material science2. Pumping systems3. Oxygenating systems4. Monitoring ( computer Science)5. Blood Salvaging6. Circulatory assistance7. Artificial heart ( remains the ultimate goal
of the Bioengineer)
Thanks for your very fervent attention...
Surgical Techniques for the Establishment of
Extracorporeal Circulation
Mr. Julius Peter Mbiydzenyuy ; Discussant: Mr. Roger Tachea
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
HEART-LUNG MACHINE
The General Idea:-
Axillary, Femoral
The procedure• Collection of Cannulae • Reception and fixation of CPB Circuit
to the Sterile camp• Standard median sternotomy or
Thoracotomy• Purse Strings• Cannulation
Types of Cannulation
• Arterial Cannulation– Aortic – Subclavian– Femoral
Venous cannulation
• Monocaval (Double stage)• Bicaval
– IVC– SVC
• Tricaval in rare cases of CHD– IVC– SVC– LSVC
• Femoral
Cannulation for Cardioplegia
• Antegrade – Ascending Aorta – aortic root
• Retrograde – Coronary sinus• Selective - Coronary ostia
Cannulation for Heart Venting
Left Heart Venting
Aortic Vent
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.
Thanks for your very fervent attention
The Use of Inotropes in Cardiac Surgery
Mr. Thierry Yunishe ; Discussant: Sr. Ruth GOOH; Mr.
Gerard Kindzeka
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
Main Goal
Tissue perfusion & oxygenation
Basic principles - Inotropes
MAP = CO x SVR
CO = HR x SV
Preload Contractility After load
+VE INOTROPES
Drug Classification
• Sympathomimetics– Naturally occurring– Synthetic
• Other inotropes– cAMP dependent– cAMP independent
Sympathomimetics
• Naturally occuring– Epinephrine– Norepinephrine– Dopamine
• Synthetic– Dobutamine– Dopexamine– Phenylephrine– Metaraminol– Ephedrine
Other inotropes
• cAMP dependent– Phosphodiesterase inhibitors
• cAMP independent– Digoxin– Calcium
Phosphodiesterase inhibitors
• Non-selective– Aminophylline
• Selective • Enoximone• milrinone • Levosidan
Receptor Sites• Adrenergic
Receptors
• Alpha 1• Alpha 2• Beta 1• Beta 2
• Dopamergic receptors
• D1• D2• D3• D4• D5
Main classes of Adrenoceptor
receptors 1
• Located in vascular smooth muscle• Mediate vasoconstriction
2
• Located throughout the CNS, platelets• Mediate sedation, analgesia & platelet
aggregation
Main classes of Adrenoceptor receptors
1• Located in the heart• Mediate increased contractility & HR
2• Located mainly in the smooth muscle of bronchi• Mediate bronchodilatation• Located in blood vessels
– Dilatation of coronary vessels– Dilatation of arteries supplying skeletal muscle
Epinephrine (Adrenaline)• Stimulates & receptors
– Predominantly effects at low doses and 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
Norepinephrine
• Predominantly stimulates 1 receptors• Most commonly used vasopressor in
critical care• Very potent• Administered by infusion into a central vein• Uses
– Hypotension due to vasodilatation– Septic shock
Dopamine
• Effect dose dependent– Direct
• Low dose - 1
• High dose - 1
– Indirect• Stimulates norepinephrine release
• D1 receptors– Vasodilatation of mesenteric & renal circulation
Dobutamine
• Synthetic• Predominantly 1
• Small effect at 2
• Uses– Low cardiac output states– Cardiogenic shock
Thanks for your kind attention
Management of Cardiac Arrhythmias after Open-Heart
Surgery
Mr. Justin Bika; Discussant: Sr. Isidora Jaff
• SA Node• Inter-nodal and inter-atrial pathways• A-V Node• Bundle of His• Perkinje Fibers
Conduction System
• 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
• Cardiac cycle– P wave = atrial depolarization– PR interval = pause between atrial and
ventricular depolarization– QRS = ventricular depolarization– T wave = ventricular depolarization
Physiology
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.
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).
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
P & P Ward experience & Mgtw.r.t types arrhythmias .
• Sinus node Dysrhythmias:• Sinus bradycardia• Sinus tachycardia• Atrial Dysrhythmias :• Premature Atrial Complex (PAC)• Atrial Flutter• Atrial fibrillation• Junctional dysrhythmias• junctional rhythm• Ventricular Dysrhythmias:• Premature Ventricular Complex (PVC)• Ventricular Tachycardia• Ventricular Fibrillation• Ventricular Asystole• Conduction Abnormalities:• First-Degree Atrioventricular Block• Second-Degree Atrioventricular Block, type 1• Second-Degree Atrioventricular Block, type 2• Third-Degree Atrioventricular Block
THANKS FOR YOUR FERVENT ATTENTION
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
1. Cardiologists Point of View
2. General Discussions
Conclusion “CARDIAC SURGERY CAN BE SIMPLY AWEFULLY CARDIAC SURGERY CAN BE AWEFULLY SIMPLY”
Thank you so much. Happy Christmas & prosperous New Year 2014
Let’s Have a common Picture outside
to commemorate this day