teknik operasi pericardial window lius
TRANSCRIPT
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Teknik Operasi Perikardiostomi
Presentan:Lius Marson Ling
Pembimbing:
dr. Rama N, Sp.BTKV
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Surgical procedure to create a window from
the pericardial space to the pleural cavity.
The excision of a portion of the pericardium,
which allows the effusion to drain
continuously into the peritoneum or chest.
Stuart J. Hutchison (10 December 2008). Pericardial diseases: clinical diagnostic imaging atlas. Elsevier
Health Sciences. pp. 93
http://books.google.com/books?id=7mZS5PS97X4C&pg=PA93http://books.google.com/books?id=7mZS5PS97X4C&pg=PA93 -
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via a smallsubxiphoid
incision
thoracoscopically via a thoracotomy
The fluid canbe drained in
any of 3
ways:
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Indications
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Indications
Cardiac tamponade (CT)
Symptomatic pericardial effusions
Asymptomatic pericardial effusions thatwarrant a pericardial window for diagnosis
Hemodynamically stable patients with an
undiagnosed pericardial effusion Coexisting pericardial, pleural, or pulmonary
pathology that requires diagnosis or therapy
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Known benign effusions that reaccumulate
after aspiration
Drainage of a purulent pericardial effusion
Loculated effusions situated unilaterally or
posteriorly
Chylopericardium Delayed hemopericardium or effusions after
cardiac surgery
Indications
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In 1935, Beck described diagnostic triad for CT
Decreasing arterial pressure1
Increasing venous pressure2
Quiet heart3
Hasan Ali Gumrukcuoglu, Dolunay Odabasi Management of Cardiac Tamponade: A Comperative Study between Echo-
Guided Pericardiocentesis and Surgery A Report of 100 Patients. Cardiology Research and Practice. Volume 2011. 19 June
2011.
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Clinical signs in patient with CT include :
Hypotension,
Tachycardia,
Pulsus paradoxus,
Raised jugular venous pressure,
Muffled heart sounds,
Decreased electrocardiographic voltage, and
Enlarged cardiac silhouette on chest x-rays
Hasan Ali Gumrukcuoglu, Dolunay Odabasi Management of Cardiac Tamponade: A Comperative Study between Echo-
Guided Pericardiocentesis and Surgery A Report of 100 Patients. Cardiology Research and Practice. Volume 2011. 19 June
2011.
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Two-dimensional echocardiographic criteria of CT were:
Accumulation of pericardial fluid creates an anechoicspace
Early diastolic collapse of the right ventricle,
Late diastolic collapse of the right or left atrium, and
Plethora of the inferior vena cava with pericardial effusion
Hasan Ali Gumrukcuoglu, Dolunay Odabasi Management of Cardiac Tamponade: A Comperative Study between Echo-
Guided Pericardiocentesis and Surgery A Report of 100 Patients. Cardiology Research and Practice. Volume 2011. 19 June
2011.
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CT Scan
http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Medicine/Pericardial_effusion2.htm
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Preparation
Anesthesia
For the subxiphoid approach, general anesthesia is
preferred and optimal. May be performed with local anesthesia plus
adequate sedation in the patient with severetamponadewho cannot tolerate general anesthesia
Arterial and central venous pressure monitoring maybe needed intraoperatively, as well as in thepostoperative period, to guide hemodynamicmanagement.
Darroch W. O. Moores, MD, Keith B. Allen, MD. Subxiphoid pericardial drainage for pericardial tamponade.J Thorac Cardiovasc Surg1995
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For the subxiphoid approach, the patient is
placed in the supine position.
Positioning
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Teknik
M.I.A. Muhammad. Interactive CardioVascular and Thoracic Surgery 12 (2011) 174178
Dale K Mueller, MD; Chief Editor: Eric H Yang, MD. Pericardial Window. http://emedicine.medscape.com/ Aug 3, 2011Darroch W. O. Moores, MD, Keith B. Allen, MD. Subxiphoid pericardial drainage for pericardial tamponade.J Thorac Cardiovasc Surg1995
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1. A short vertical incision (about 5-8 cm long) is made over the
xiphoid, extending onto the midline of the abdomen
2. The linea alba is incised, and the xiphoid is split or often
completely removed.
3. The retrosternal space is entered by means of finger dissection.
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4. With upward retraction, the distal sternum is elevated, thediaphragmatic aspect of the pericardium is visualized
5. The pericardium is grasped with the hook or Allis clamp,
alternatively, it may be incised directly.
6. The opening in the pericardium is enlarged by sharply incising the
pericardium.
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7. A sucker is inserted into the pericardial space and the fluid aspirated.
8. Fluid is sent for bacteriologic andcytologic analyses
9. Often, this sucker or a finger is used for further dissection of any
adhesions.
10. A biopsy specimen is also taken from the pericardium.
11. After all the fluid has been aspirated, the epicardium is inspected.
12. A finger is introduced into the pericardial space to determine if any
additional adhesions exist and if any nodules are in the pericardium.
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12. Finally, through a separate stab wound, a 28 F chest tube is
inserted into the pericardial space and connected
It is important to place the chest tube through a separate
incision because a chest tube left inthe operative wound can
lead to improper wound healing, woundinfection
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13. the incision is closed in layers with absorbable sutures
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The chest tube is left in placefor 4 to 5 days
after the operation.
The chest tube was removed when the
amount of daily drainage was < 100 ml.
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Komplikasi
Perdarahan
infeksi
Arrhythmia cardiac arrest
mortality
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TERIMA KASIH