Adult Cardiac Surgery

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Adult Cardiac Surgery"

Transcription

1 Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan

2 Adult Cardiac Surgery: Ischemic Heart Disease (History) William Heberden described angina pectoris. Claude Beck 1930 s- sought to increase myocardial blood flow indirectly with pericardial fat and omentum. Arthur Vineberg 1940 s- Mobilization of left internal mammary artery with implantation of bleeding end into the left ventricle follow-up study on 140 patients 33% mortality 85% relief from angina

3

4 Adult Cardiac Surgery: Ischemic Heart Disease (History) John H. Gibbon, Jr. Heart-lung machine May ASD closure

5 Adult Cardiac Surgery: Ischemic Heart Disease (History) KOLOSOV in Russia LIMA LAD David C. Sabiston, Jr.- Aortocoronary saphenous vein bypass Rene Favaloro Cleveland Clinic Frank Spencer/George Green Internal mammary artery

6 Adult Cardiac Surgery: Ischemic Heart Disease (CABG) Early and widespread acceptance of coronary bypass was delayed. Best known cooperative studies ( s) were the; VA Coronary Artery Surgery Study European Coronary Surgery Study

7 The Normal Heart - Coronary Artery Anatomy Left Main CA Circumflex Layers of the Arterial Wall Right CA Left Anterior Descending CA Marginal Branch Media Intima Adventitia Intima composed of endothelial cells

8

9 Pathogenesis of ACS

10 ATHEROSCLEROSIS

11 Risk Factors Uncontrollable Sex Hereditary Race Age Controllable High blood pressure High blood cholesterol Smoking Physical activity Obesity Diabetes Stress and anger 11

12 Indications for open-heart surgery Coronary heart disease: (CABG) Triple vessel disease Lf main coronary artery disease Unstable angina,failed Mx therapy Complications of PTCA Life threatening complications of MI

13 Adult Cardiac Surgery: CABG Techniques Median sternotomy Cardiopulmonary bypass Cardioplegic arrest Mammary artery, reversed saphenous vein, radial artery Minimally access incisions (Port Access) Off-pump

14

15 Adult Cardiac Surgery: CABG Techniques

16

17 Heart Lung Machine

18

19

20

21

22 Anatomy of heart valves

23 Anatomy MV: 2Cusps, Anterior and posterior The Ant is the larger Intervenes bet. A-V and aortic orifice AV: 3 semilunar cusps, ant (RT), post. Wall (LT and post) TV; 3cusps, ant, septal,post. PV; 3 semilunar cusps one post. (lt) two ant( ant and rt)

24 AVS tricuspid and bicuspid calcifications

25 Adult Cardiac Surgery: Valvular Heart Disease Aortic stenosis- Age-related degenerative Mild AS: AVA > 1.5cm 2 ; Moderate 1-1.5cm 2 ; Severe <1cm 2 Indications for surgery largely based on symptoms Syncope, angina, dyspnea and CHF Aortic regurgitation- Calcific aortic disease, idiopathic degenerative disease, endocarditis, rheumatic disease, bicuspid valve, aortic dissection, Marfan, etc. Indications for surgery Acute AR- inadequate time for ventricular compensation Chronic AR- symptoms, decreasing EF, LVEDD >75mm, LVESD >55mm

26 Pathophysiolgy of AS Except in the congenital forms, AS develops slowly The LV becomes increasingly hypertrophied, and coronary blood flow may become inadequate The fixed outflow obstruction limits the increase in C.O required on exercise. The progressive LV outflow obstruction results in increased LV mass. This increase in wall thickness is a compensatory mechanism to normalize LV wall stress

27 Symptoms of AS Exertional dyspnea Angina Pulmonary edema Exertional syncope Sudden death

28 Signs of AS Ejection systolic murmur Slow rising carotid pulse Reduce pulse pressure LV hypertrophy Signs of LV failure (crepitations, pulmonary edema)

29 Investigations ECG CXR ECHO CATH

30 ECHO criteria for assessment of aortic stenosis severity mild moderate severe critical Mean gradient(mmhg) < >50 >80 Aortic valve area (cm2) > <1 <0.7

31 Recommendations for Aortic Valve Replacement in Aortic Stenosis Symptomatic patients with severe AS Patients with severe AS undergoing coronary artery bypass surgery Patients with severe AS undergoing surgery on the aorta or other heart valves Patients with moderate AS undergoing coronary artery bypass surgery or surgery on the aorta or other heart valves Asymptomatic patients with severe AS and the following;

32 Asymptomatic patients with severe AS and the following LV systolic dysfunction Abnormal response to exercise (e.g. hypotension) Ventricular tachycardia Marked or excessive LVH (>15 mm) Valve area <0.6 cm2 Prevention of sudden death in asymptomatic patients with none of the findings listed under asymptomatic patients with severe AS

33 Adult Cardiac Surgery: Valve Prostheses Mechanical Valves Caged-ball valves Tilting disc valves single leaflet bileaflet Tissue Valves Animal tissue (porcine aortic valves, bovine pericardium) Human tissue (Homografts, Autografts)

34 Mechanical valves ball and cage bileaflet

35 Mechanical valves tilting-disc valve

36 Bioprosthetic Valves Aortic homograft Human tissue valves autograft homograft Animal tissue valves Heterograft or xenograft

37 Adult Cardiac Surgery

38 How to choose a valve Mechanical valve in patients < 65years. Tissue valves in patients > 65 years Tissue valves in patients whose life expectancy is < 10 year Tissue valve in patients who have problems which are likely to cause life threatening bleeding.

39 Adult Cardiac Surgery: Aortic Valve Replacement Median sternotomy, hemi-sternotomy Cardiopulmonary bypass Cardioplegic arrest Excision of the valve Debridement Implantation

40

41 Adult Cardiac Surgery: ACC/AHA Aortic position Bileaflet- INR of 2-3 Other disk valves and Starr-Edwards- INR In patients with higher risk of TE, INR with addition of aspirin mg/d. (AF, EF, prior TE, hypercoagulable state) Mitral position All- INR

42 Adult Cardiac Surgery: ACC/AHA Tissue prosthesis- Anticoagulation recommended in first 3 months, although aspirin alone in aortic position in some centers. INR After 3 months, discontinue unless other circumstances

43 THANK YOU

PBL - Cardiac Surgery lecture 3

PBL - Cardiac Surgery lecture 3 In this sheet we will talk about Adult Cardiac Surgery and what are the most common diseases that need cardiac surgery in adulthood. Please refer to the slides, I wrote only what doctor said, & the slides

More information

Heart Valves: Before and after surgery

Heart Valves: Before and after surgery Heart Valves: Before and after surgery Tim Sutton, Consultant Cardiologist Middlemore Hospital, Auckland Auckland Heart Group Indications for intervention in Valvular disease To prevent sudden death and

More information

Cardiovascular Structure & Function

Cardiovascular Structure & Function Cardiovascular Structure & Function Cardiovascular system: The heart Arteries Veins Capillaries Lymphatic vessels Weighting of the heart ceremony: Ancient Egyptians William Harvey and Blood Flow April

More information

Cardiovascular System Notes: Heart Disease & Disorders

Cardiovascular System Notes: Heart Disease & Disorders Cardiovascular System Notes: Heart Disease & Disorders Interesting Heart Facts The Electrocardiograph (ECG) was invented in 1902 by Willem Einthoven Dutch Physiologist. This test is still used to evaluate

More information

Cardiac catheterisation in AS

Cardiac catheterisation in AS AORTIC STENOSIS MANAGEMENT OF VALVULAR AORTIC STENOSIS Dr Badri Paudel Third most common cardiovascular disease Most prevalent valvular heart disease in the world Commonest acquired valvular lesion with

More information

TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair?

TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? Elaine E. Tseng, MD and Marlene Grenon, MD Department of Surgery Divisions of Adult Cardiothoracic and Vascular and Endovascular

More information

Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new

Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new B. Sonnenberg UAH Cardiology CME Day 5 May 2015 Disclosures Speaker s or Advisory Boards: none Research grants: none (co-investigator

More information

The Cardiovascular System Part I: Heart Outline of class lecture After studying part I of this chapter you should be able to:

The Cardiovascular System Part I: Heart Outline of class lecture After studying part I of this chapter you should be able to: The Cardiovascular System Part I: Heart Outline of class lecture After studying part I of this chapter you should be able to: 1. Describe the functions of the heart 2. Describe the location of the heart,

More information

The Heart and Heart Disease

The Heart and Heart Disease The Heart and Heart Disease Illustration of the heart by Leonardo DaVinci heart-surgeon.com/ history.html 2/14/2010 1 I. Location, Size and Position of the Heart A. Triangular organ located 1. of mass

More information

Introducing the COAPT Trial

Introducing the COAPT Trial physician INFORMATION Eligible patients Symptomatic functional mitral regurgitation 3+ Not suitable candidates for open mitral valve surgery NYHA functional class II, III, or ambulatory IV Introducing

More information

Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants

Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal

More information

The heart=a muscular double pump with 2 functions Overview

The heart=a muscular double pump with 2 functions Overview The Heart 1 The heart=a muscular double pump with 2 functions Overview The right side receives oxygen-poor blood from the body and tissues and then pumps it to the lungs to pick up oxygen and dispel carbon

More information

Chapter 14. The Cardiovascular System

Chapter 14. The Cardiovascular System Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2

More information

A Health Care Professional s Guide Aortic Stenosis in Seniors

A Health Care Professional s Guide Aortic Stenosis in Seniors A Health Care Professional s Guide Aortic Stenosis in Seniors With highlights from the 2014 ACC/AHA practice guidelines for valve disease Aortic stenosis (AS) is primarily caused by calcification of the

More information

10. Thick deposits of lipids on the walls of blood vessels, called, can lead to serious circulatory issues. A. aneurysm B. atherosclerosis C.

10. Thick deposits of lipids on the walls of blood vessels, called, can lead to serious circulatory issues. A. aneurysm B. atherosclerosis C. Heart Student: 1. carry blood away from the heart. A. Arteries B. Veins C. Capillaries 2. What is the leading cause of heart attack and stroke in North America? A. alcohol B. smoking C. arteriosclerosis

More information

PATIENT BOOKLET MEDTRONIC SURGICAL VALVE REPLACEMENT. Tissue Valve for Aortic and Mitral Valve Replacement

PATIENT BOOKLET MEDTRONIC SURGICAL VALVE REPLACEMENT. Tissue Valve for Aortic and Mitral Valve Replacement PATIENT BOOKLET MEDTRONIC SURGICAL VALVE REPLACEMENT Tissue Valve for Aortic and Mitral Valve Replacement ARE MEDTRONIC SURGICAL TISSUE HEART VALVES RIGHT FOR YOU? Medtronic surgical heart valves are for

More information

MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT. Irene Frantzis P year, SGUL Sheba Medical Center

MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT. Irene Frantzis P year, SGUL Sheba Medical Center MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT Irene Frantzis P year, SGUL Sheba Medical Center MITRAL VALVE DISEASE Mitral Valve Regurgitation Mitral Valve Stenosis Mitral Valve Prolapse MITRAL REGURGITATION

More information

ICE: Echo Core Lab-CRF

ICE: Echo Core Lab-CRF APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction

More information

Cardiac Radiography. Jared D. Christensen, M.D.

Cardiac Radiography. Jared D. Christensen, M.D. Cardiac Radiography Jared D. Christensen, M.D. Cardiac radiography Jared D. Christensen, M.D. Overview Basic Concepts Technique Normal anatomy Cases Technique 3 Standard Views Posterior-Anterior (PA) Anterior-Posterior

More information

Clinical Indications for Echocardiography

Clinical Indications for Echocardiography Clinical Indications for Echocardiography Echocardiography is widely utilised and potential applications are increasing with advances in technology. The aim of this document is two-fold: 1) To define clinical

More information

cardiac imaging planes planning basic cardiac & aortic views for MR

cardiac imaging planes planning basic cardiac & aortic views for MR cardiac imaging planes planning basic cardiac & aortic views for MR Dianna M. E. Bardo, M. D. Assistant Professor of Radiology & Cardiovascular Medicine Director of Cardiac Imaging cardiac imaging planes

More information

8/31/2016. Mitraclip in Matthew Johnson, MD

8/31/2016. Mitraclip in Matthew Johnson, MD Mitraclip in 2016 Matthew Johnson, MD 1 Abnormal Valve Function Valve Stenosis Obstruction to valve flow during that phase of the cardiac cycle when the valve is normally open. Hemodynamic hallmark - pressure

More information

Aortic Valve Lesions

Aortic Valve Lesions Version 1.0 Valvular Heart Disease 25/03/2012 Aortic Stenosis Aortic Valve Lesions General Most common isolated affected valve, esp elderly 4M:1F Unrecognised can be important cause of anaesthetic & obstetric

More information

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER:

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER: ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM General Instructions: The Heart Failure Hospital Record Abstraction Form is completed for all heart failure-eligible cohort hospitalizations. Refer to

More information

From Valve to Arch: How s Your Aorta? March 7, 2011

From Valve to Arch: How s Your Aorta? March 7, 2011 From Valve to Arch: How s Your Aorta? March 7, 2011 Susan Housholder-Hughes, RN, MSN, ANP-BC, FAHA, AACC Nurse Practitioner, Multidisciplinary Aortic Program Cardiovascular Center Adjunct Clinical Instructor,

More information

Rhythm Disorders 2017 TazKai LLC and NRSNG.com

Rhythm Disorders 2017 TazKai LLC and NRSNG.com Rhythm Disorders 1. Outline the conduction system of the heart. 2. What do the different portions of the EKG represent? 3. Define the following terms: a. Automaticity b. Conductivity c. Excitability d.

More information

Cardiovascular Recommendation Tables

Cardiovascular Recommendation Tables Cardiovascular Recommendation Tables Current as of: February, 2009 The first publication of the Cardiovascular Recommendation Tables occurred in the October 2002, Cardiovascular Advisory Panel Guidelines

More information

HEART CONDITIONS IN SPORT

HEART CONDITIONS IN SPORT HEART CONDITIONS IN SPORT Dr. Anita Green CHD Risk Factors Smoking Hyperlipidaemia Hypertension Obesity Physical Inactivity Diabetes Risks are cumulative (multiplicative) Lifestyles predispose to RF One

More information

4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium.

4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium. Answer each statement true or false. If the statement is false, change the underlined word to make it true. 1. The heart is located approximately between the second and fifth ribs and posterior to the

More information

Regurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA

Regurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Regurgitant Lesions Bicol Hospital, Legazpi City, Philippines July 2016 Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Aortic Insufficiency Valve anatomy and function LVOT and

More information

ESC/EACTS Guidelines for the Management of Valvular Heart Disease

ESC/EACTS Guidelines for the Management of Valvular Heart Disease ES/EATS Guidelines for the Management of Valvular Heart Disease European Journal of ardio-thoracic Surgery 2012 - Why do we need new guidelines on the management of valvular disease? New evidence has been

More information

AP2 Lab 3 Coronary Vessels, Valves, Sounds, and Dissection

AP2 Lab 3 Coronary Vessels, Valves, Sounds, and Dissection AP2 Lab 3 Coronary Vessels, Valves, Sounds, and Dissection Project 1 - BLOOD Supply to the Myocardium (Figs. 18.5 &18.10) The myocardium is not nourished by the blood while it is being pumped through the

More information

Understanding the guidelines for Interventions in MR. Ali AlMasood

Understanding the guidelines for Interventions in MR. Ali AlMasood Understanding the guidelines for Interventions in MR Ali AlMasood Mitral regurgitation The most diverse from all acquired valve diseases About 50% of patients with an LVEF 35 percent had moderate to severe

More information

2.02 Understand the functions and disorders of the circulatory system

2.02 Understand the functions and disorders of the circulatory system 2.02 Understand the functions and disorders of the circulatory system 2.02 Understand the functions and disorders of the circulatory system Essential questions: What are the functions of blood? What are

More information

Cardiac MRI: Clinical Application to Disease

Cardiac MRI: Clinical Application to Disease Cardiac MRI: Clinical Application to Disease Jessi Smith, MD Cardiothoracic imaging, Indiana University Slides courtesy of Stacy Rissing, MD Outline Imaging planes Disease findings Pulse sequences used

More information

Mitral Valve Disease, When to Intervene

Mitral Valve Disease, When to Intervene Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages

More information

Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials

Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials Pregnancy and Congenital Heart Disease Case Review Heidi M. Connolly, M.D. Professor of Medicine Chair for Education

More information

For more information about how to cite these materials visit

For more information about how to cite these materials visit Author: Michael Shea, M.D., 2008 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

More information

12 Lead ECG Interpretation

12 Lead ECG Interpretation 12 Lead ECG Interpretation Julie Zimmerman, MSN, RN, CNS, CCRN Significant increase in mortality for every 15 minutes of delay! N Engl J Med 2007;357:1631-1638 Who should get a 12-lead ECG? Also include

More information

Circulatory system. Lecture #2

Circulatory system. Lecture #2 Circulatory system Lecture #2 The essential components of the human cardiovascular system: Heart Blood Blood vessels Arteries - blood vessels that conduct arterial blood from heart ventricle to organs

More information

Cardiovascular System

Cardiovascular System Cardiovascular System Blood vessels, heart and blood Functions Transport oxygen, nutrients, waste, hormones White blood cells fighting disease Temperature regulation Blood vessels; Arteries Arteries carry

More information

Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders Chapter 29 Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders LEARNING OBJECTIVES On completion of this chapter, the learner will be able to: 1. Define valvular disorders

More information

Local Coverage Determination (LCD) for Cardiac Catheterization (L29090)

Local Coverage Determination (LCD) for Cardiac Catheterization (L29090) Local Coverage Determination (LCD) for Cardiac Catheterization (L29090) Contractor Information Contractor Name First Coast Service Options, Inc. Contractor Number 09102 Contractor Type MAC - Part B LCD

More information

Chapter 20: Cardiovascular System: The Heart

Chapter 20: Cardiovascular System: The Heart Chapter 20: Cardiovascular System: The Heart I. Functions of the Heart A. List and describe the four functions of the heart: 1. 2. 3. 4. II. Size, Shape, and Location of the Heart A. Size and Shape 1.

More information

Common Codes for ICD-10

Common Codes for ICD-10 Common Codes for ICD-10 Specialty: Cardiology *Always utilize more specific codes first. ABNORMALITIES OF HEART RHYTHM ICD-9-CM Codes: 427.81, 427.89, 785.0, 785.1, 785.3 R00.0 Tachycardia, unspecified

More information

DISSECTION OF A SHEEP HEART

DISSECTION OF A SHEEP HEART DISSECTION OF A SHEEP HEART I. INTRODUCTION A. You will soon appreciate the point made previously the heart models just don t teach us what a real heart is like! Dissecting a sheep heart will give you

More information

The Ross Procedure: Outcomes at 20 Years

The Ross Procedure: Outcomes at 20 Years The Ross Procedure: Outcomes at 20 Years Tirone David Carolyn David Anna Woo Cedric Manlhiot University of Toronto Conflict of Interest None The Ross Procedure 1990 to 2004 212 patients: 66% 34% Mean age:

More information

Circulatory System Notes

Circulatory System Notes Circulatory System Notes Functions of Circulatory System A. Transports B. Transports C. Transports D. Transports E. of fluids F. G. Regulate temperature H. Blood clotting Characteristics of various blood

More information

Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency

Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency Bicuspid Aortic Valve Repair in the Setting of Severe Aortic Insufficiency Edward P. Chen MD Director Thoracic Aortic Surgery Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta,

More information

Stress Testing in Valvular Disease

Stress Testing in Valvular Disease 2017 ASE Florida Orlando, FL October 10, 2017 2:40 2:50 PM 10 min Grand Harbor Ballroom South Stress Testing in Valvular Disease Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate

More information

New Cardiovascular Devices and Interventions: Non-Contrast MRI for TAVR Abhishek Chaturvedi Assistant Professor. Cardiothoracic Radiology

New Cardiovascular Devices and Interventions: Non-Contrast MRI for TAVR Abhishek Chaturvedi Assistant Professor. Cardiothoracic Radiology New Cardiovascular Devices and Interventions: Non-Contrast MRI for TAVR Abhishek Chaturvedi Assistant Professor Cardiothoracic Radiology Disclosure I have no disclosure pertinent to this presentation.

More information

How to Assess and Treat Obstructive Lesions

How to Assess and Treat Obstructive Lesions How to Assess and Treat Obstructive Lesions Erwin Oechslin, MD, FESC, FRCPC, Director, Congenital Cardiac Centre for Adults Peter Munk Cardiac Centre University Health Network/Toronto General Hospital

More information

Notes by Sandra Dankwa 2009 HF- Heart Failure DS- Down Syndrome IE- Infective Endocarditis ET- Exercise Tolerance. Small VSD Symptoms -asymptomatic

Notes by Sandra Dankwa 2009 HF- Heart Failure DS- Down Syndrome IE- Infective Endocarditis ET- Exercise Tolerance. Small VSD Symptoms -asymptomatic Congenital Heart Disease: Notes. Condition Pathology PC Ix Rx Ventricular septal defect (VSD) L R shuntsdefect anywhere in the ventricle, usually perimembranous (next to the tricuspid valve) 30% 1)small

More information

2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease

2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease 2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease Patrick T. O Gara, MD BWH Heart and Vascular Center Professor of Medicine, Harvard Medical School Disclosures NHLBI CTSN Co-chair

More information

CIRCULATORY SYSTEM BLOOD VESSELS

CIRCULATORY SYSTEM BLOOD VESSELS Name: Block: CIRCULATORY SYSTEM Multicellular organisms (above the level of roundworms) rely on a circulatory system to bring nutrients to, and take wastes away from, cells. In higher organisms such as

More information

Heart. Structure Physiology of blood pressure and heartbeat

Heart. Structure Physiology of blood pressure and heartbeat Heart Structure Physiology of blood pressure and heartbeat Location and Anatomy Location and Anatomy Pericardial cavity: surrounds, isolates, and anchors heart Parietal pericardium lined with serous membrane

More information

THE HEART. A. The Pericardium - a double sac of serous membrane surrounding the heart

THE HEART. A. The Pericardium - a double sac of serous membrane surrounding the heart THE HEART I. Size and Location: A. Fist-size weighing less than a pound (250 to 350 grams). B. Located in the mediastinum between the 2 nd rib and the 5 th intercostal space. 1. Tipped to the left, resting

More information

Anatomy & Physiology of Cardiovascular System. Chapter 18 & 19

Anatomy & Physiology of Cardiovascular System. Chapter 18 & 19 Anatomy & Physiology of Cardiovascular System Chapter 18 & 19 Objectives..cont 1. Discuss the physiological stages of cardiac muscle contraction. 2. Trace a typical ECG and label each wave or complex 3.

More information

Congenital heart disease. By Dr Saima Ali Professor of pediatrics

Congenital heart disease. By Dr Saima Ali Professor of pediatrics Congenital heart disease By Dr Saima Ali Professor of pediatrics What is the most striking clinical finding in this child? Learning objectives By the end of this lecture, final year student should be able

More information

Echo Emergencies. Outline. Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures

Echo Emergencies. Outline. Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures Echo Emergencies Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures Outline Common emergency / on call scenarios Tamponade Pulmonary embolism/rv strain Cardiogenic

More information

CMS Limitations Guide - Cardiovascular Services

CMS Limitations Guide - Cardiovascular Services CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

EVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE. Karen Stout, MD University of Washington Seattle Children s Seattle, WA

EVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE. Karen Stout, MD University of Washington Seattle Children s Seattle, WA EVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE Karen Stout, MD University of Washington Seattle Children s Seattle, WA CASE PRESENTATION 24 year old woman with aortic regurgitation referred for evaluation

More information

Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know

Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know James F. Burke, MD Program Director Cardiovascular Disease Fellowship Lankenau Medical Center Disclosure Dr. Burke has no conflicts

More information

Cardiovascular System Notes: Physiology of the Heart

Cardiovascular System Notes: Physiology of the Heart Cardiovascular System Notes: Physiology of the Heart Interesting Heart Fact Capillaries are so small it takes ten of them to equal the thickness of a human hair. Review What are the 3 parts of the cardiovascular

More information

Hardware in the Chest - From VADs to Valves

Hardware in the Chest - From VADs to Valves Hardware in the Chest - From VADs to Valves Cristina Fuss, MD Purpose Recognize the device Indication and function Cristina Fuss, MD Department of Diagnostic Radiology FROM VADS TO VALVES Implanting technique

More information

7. Echocardiography Appropriate Use Criteria (by Indication)

7. Echocardiography Appropriate Use Criteria (by Indication) Criteria for Echocardiography 1133 7. Echocardiography Criteria (by ) Table 1. TTE for General Evaluation of Cardiac Structure and Function Suspected Cardiac Etiology General With TTE 1. Symptoms or conditions

More information

Heart Dissection. 5. Locate the tip of the heart or the apex. Only the left ventricle extends all the way to the apex.

Heart Dissection. 5. Locate the tip of the heart or the apex. Only the left ventricle extends all the way to the apex. Heart Dissection Page 1 of 6 Background: The heart is a four-chambered, hollow organ composed primarily of cardiac muscle tissue. It is located in the center of the chest in between the lungs. It is the

More information

Surgical Treatment for Valvular Heart Disease

Surgical Treatment for Valvular Heart Disease Chapter 34 Surgical Treatment for Valvular Heart Disease Peter J. K. Starek Competency of the atrioventricular valves allows blood to enter the ventricles, where pressure is generated. When adequate systolic

More information

Reoperation after previous Ross procedure

Reoperation after previous Ross procedure Reoperation after previous Ross procedure Victor Tsang Society of Thoracic Surgeons of Thailand 2016 As a living autograft, the transplanted pulmonary valve has the prospect of long term or permanent survival.

More information

Heart Facts. The average adult heart beats 72 times a min 100,000 times a day 3,600,000 times a year 2.5 billion times during a lifetime.

Heart Facts. The average adult heart beats 72 times a min 100,000 times a day 3,600,000 times a year 2.5 billion times during a lifetime. Circulatory System Heart Facts The average adult heart beats 72 times a min 100,000 times a day 3,600,000 times a year 2.5 billion times during a lifetime. Heart Facts Weighs 11 oz A healthy heart pumps

More information

M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE. Sampling Rate M-Mode: 1800 / sec 2D: 30 / sec

M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE. Sampling Rate M-Mode: 1800 / sec 2D: 30 / sec M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE Honoraria: Philips Classical M-mode Echocardiography M-Mode offers better time and image resolution. Sampling Rate M-Mode: 1800 / sec

More information

Computed Tomography - From basics to clinical use Diagnosis and Treatment of Valvular Heart Disease. David Messika-Zeitoun

Computed Tomography - From basics to clinical use Diagnosis and Treatment of Valvular Heart Disease. David Messika-Zeitoun Computed Tomography - From basics to clinical use Diagnosis and Treatment of Valvular Heart Disease David Messika-Zeitoun Disclosures Lectures fees for Edwards, Abbott Consultant fees from Symetis You

More information

ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT

ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT Karen Stout, MD, FACC Divisions of Cardiology University of Washington Medical Center Seattle Children s Hospital NO DISCLOSURES

More information

Cardiovascular Anatomy Dr. Gary Mumaugh

Cardiovascular Anatomy Dr. Gary Mumaugh Cardiovascular Anatomy Dr. Gary Mumaugh Location of Heart Approximately the size of your fist Location o Superior surface of diaphragm o Left of the midline in mediastinum o Anterior to the vertebral column,

More information

The Cardiovascular and Lymphatic Systems Cardiovascular System Blood Vessels Blood Vessels Arteries Arteries Arteries

The Cardiovascular and Lymphatic Systems Cardiovascular System Blood Vessels Blood Vessels Arteries Arteries Arteries CH 12 The Cardiovascular and s The Cardiovascular and s OUTLINE: Cardiovascular System Blood Vessels Blood Pressure Cardiovascular System The cardiovascular system is composed of Blood vessels This system

More information

Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery

Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery Aortic stenosis (AS) is characterized as a high-risk index for cardiac complications during non-cardiac surgery. A critical analysis of old

More information

Minimally Invasive Mitral Valve Surgery: Not Another Flash in the Pan The MUSC Experience

Minimally Invasive Mitral Valve Surgery: Not Another Flash in the Pan The MUSC Experience Minimally Invasive Mitral Valve Surgery: Not Another Flash in the Pan The MUSC Experience MUSC Minimally Invasive Cardiac Surgery Mario Castillo- Sang, MD Assistant Professor of Surgery Division of Cardiothoracic

More information

The pericardial sac is composed of the outer fibrous pericardium

The pericardial sac is composed of the outer fibrous pericardium Pericardiectomy for Constrictive or Recurrent Inflammatory Pericarditis Mauricio A. Villavicencio, MD, Joseph A. Dearani, MD, and Thoralf M. Sundt, III, MD Anatomy and Preoperative Considerations The pericardial

More information

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Session Guidelines This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars on the 3 rd Wednesday of each month to address topics related to risk adjustment

More information

Dr Felix Keng. Imaging of the heart is technically difficult because: Role of Cardiac MSCT. Current: Cardiac Motion Respiratory Motion

Dr Felix Keng. Imaging of the heart is technically difficult because: Role of Cardiac MSCT. Current: Cardiac Motion Respiratory Motion Siemens Philips Dr Felix Keng GE Toshiba Role of Cardiac MSCT Current: Structural / congenital heart imaging Extra-cardiac / Great vessel imaging Volumes and ejection fractions (cine + gating) Calcium

More information

BLOOD I. Composition and Function of Blood

BLOOD I. Composition and Function of Blood BLOOD I. Composition and Function of Blood A. Components 1. Blood is the only fluid tissue 2. Has living blood cells and nonliving fluid matrix 3. Breakdown of blood sample a. Formed elements b. Plasma

More information

Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA

Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA Case History A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that began after

More information