Cardiac Surgery and PCI

What does Percutaneous mean?
A puncture rather than incision. The groin, over the Femoral Artery, is the site of most Percutaneous Coronary Intervention.

What is the Gold Standard of diagnosing Coronary Atherosclerosis?
Angiogram.

What is a Judkins Catheter?
What is a Judkins Catheter?
A coronary Catheter that has a Right or Left bend.

Judkins Left is for Ascending Aorta, Pigtail is for piercing the Aortic Valve.

What is PTCA?
Percutaneous Translumenal Coronary Angioplasty.

It can be with a Stent or a Balloon.

What is the advantage and disadvantage of a Stent vs a Balloon?
What is the advantage and disadvantage of a Stent vs a Balloon?
You will need to take anticoagulants for the rest of your life, so you must be able to take them. The stent is very helpful in large artery occlusions.

Is the balloon in the balloon catheter filled with air?
Is the balloon in the balloon catheter filled with air?
No, it is usually filled with Contrast Medium so we can see it inflate.

Who is Dr Forssmann?
Who is Dr Forssmann?
A pioneer who threaded a Catheter into his own heart in 1929. This is the Xray he took.

Contrast Bare Metal Stents and Drug Eluding Stents?
Drug Eluding Stents are coated with Steroids which decrease the intimal Hyperplasia, but they tend to thrombose a few years later. You must be on Plavix and Aspirin for at least a year if not life.

Bare Metal Stents require anticoagulation for only 3 Months, but they have a higher rate of complications.

Contrast PCI and CABG.
Contrast PCI and CABG.
Percutaneous Coronary Intervention is a shorter and more painless procedure. However, it requires more frequent procedures such as Angiogram and second PCI.

What is TAVR?
What is TAVR?
Transcatheter Aortic Valve Replacement is a technique to replace the Aortic Valve without stopping the heart. It carries risk of Vasuclar Complications and is reserved for those too sick for Open Heart Surgery.

It uses a Compressible Valve sort of like a stent.

When is Coronary Artery Bypass Grat indicated?
CABG is used often for Left Main Coronary Artery Stenosis, or if complications occur with Percutaneous intervention such as Stent Failure.

Contrast IMA vs SVG as conduits for Bypass.
Contrast IMA vs SVG as conduits for Bypass.
Internal Mammary Artery has better patency requiring fewer future procedures, but a more difficult surgery because it is smaller and more delicate.

It looks a bit burned as Anterior Intercostals have been Cauterized and Transversus Thoracis cut.

Contrast Beating Heart surgery and Cardiac Arrest surgery.
With the heart stopped, it is easier to make stitches etc.

With the heart not stopped it is a more difficult surgery with a faster recovery, although enthusiasm may be waning.

Contrast Mechanical and Biological Valve.
Contrast Mechanical and Biological Valve.
Biological last only about 10 years but require less anticoagulation. They are also silent.

Median sternotomy (incision down middle of sternum) = majority of cardiac surgery Open heart surgery procedure -> GA -> median sternotomy -> soft tissues parted -> pericardium opened -> heart and aorta exposed Cardiopulmonary bypass connected, electrical and mechanical activity …

Percutaneous coronary intervention entail a variety of procedure used to completely alleviate or reduce the symptoms of coronary heart disease, one such procedure is the balloon angioplasty which involves the inflation of a balloon guided using a wire, which produces …

Coronary Heart Disease… … is the term used to describe the effect of a reduction or complete obstruction of blood flow through the coronary arteries due to narrowing from atherosclerosis Coronary Heart Disease Usually presents as: • chest pain • …

Medical Stent is a tiny tube medical device placed into an artery, blood vessel, or other duct to hold the structure open when conducting a medical procedure called stenting. Over the years, there have been different kinds of stents which …

Pre-Op teaching -Shower with Chlorhexidine the evening before and the morning of -Intranasal mupirocin (Bactroban) for 5 days/begin 2 days prior to surgery – helps reduce the colonization of MRSA in the nose -If diebetic, importance of glucose control. Often …

Cardiac Catheterization ->done during MI or to dx to see inside heart ->reveals problems w/ valves or vessels ->determines what is needed: i.e, Valve Repair, CABG CABG: coronary artery bypass graphic ->Most common type of cardiac surgery & for older …

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