Saat2 akhir SEM 4

ASsalam......ni tgh2 pagi ni saye nak berkongsi lah ckit peengalaman research sayer....heheeh secare keseluruhannyer mmg best sebenarnye.....cume tetibe ade sesuatu yg kurang enak blaku n sagt dissapointed r bler ade gak org sanggup buat cmnie...tp nak wat cmner die dah wat pun tp mmg ade baek n buruknyer.......mmg bnyk pengajaran yg di terima drpd research nie,,,,sgt2 (x taw nak gambarkan n tuliskan) tp harap2 research kami nie akan berjaye....lagi satu semoge di usia nak masuk tahun 3 medic nie akan mematangkan setiap org termasuk diri ini supaye tdk tersalah membuat sesuatu keputusan sebelum berfikir....lagi satu aq dah kene set niat untuk belajar dgn ;ebih tekun dan untuk diri sendiri supaya matlamat tidak tersasar lagi...mmg bayk suke dan duke dalam perjalanan sebagai seorg pelajar perubtn...mgkn dgn ujian yg diterima akan memberi persediaan untuk diri ini menempuhi masa hadapan yg lebih mencabar....SAPA TAHUKAN??? so semoge secebis bingkisan ni dapat mengurangkan sedikit beban yg telah ade dlm kepala nie hehehe....n semoge berjaya untuk semua medic 2nd year yg present sok chaiyok2!!!!!sekian

High Skilled Cardiology Surgeries

Norwood Procedure

This is normally performed within a few days of birth or diagnosis of Hypoplastic Left Heart Syndrome, whilst the Ductus Arteriosus is being kept open with Prostaglandin therapy.

Modified Norwood Procedure

The aims of the first operation are:

(a) To improve the flow of red blood (oxygenated blood) around the body by attaching the base (Trunk) of the lung artery (Pulmonary Artery) to the body artery (Aorta). It may be necessary to enlarge the body artery with a patch.

(b) To provide a blood flow to the lungs through a passage (Shunt), creating a link between the lung artery (Pulmonary Artery) and the body artery (Aorta). The passage is made out of soft plastic (Gore-Tex).

(c) To create a permanent passage (septectomy) between the collecting chambers (Left and Right Atrium) ensuring that a mix of red (oxygenated) blood and blue (deoxygenated) blood is flowing around the body.

This operation is extremely complicated and holds a high risk (chance of the baby

dying). Ask your surgeon about the risk for your child. The baby may need to be

in hospital for some weeks following this surgery to ensure that the baby’s

condition is stable before discharge home.

Batista Procedure

The Batista Operation Procedure was developed by Brazilian surgeon Dr. Randas J. V.  Batista, as a treatment for heart failure. Technically called as  reduction left ventriculoplasty, the Batista operation is a procedure that was primarily developed for patients with dilated left ventricles and severe heart failure. 

 

 

It is an open heart operation performed with the help of a heart-lung machine in order to maintain blood circulation while the heart is stopped. The essence of the procedure is to remove a block present in the left ventricle muscle and then stitch together the two edges of the left ventricle. By doing this, the size of the left ventricle is reduced, and the ventricle is remodelled as well. The Batista procedure was an experimental open heart surgery to reverse the effects of remodelling. This operation was carried on patients who were suffering from enlarged left ventricle because of which the blood was not being pumped efficiently. In the Batista procedure, an elliptical piece of living heart tissue is removed from the left ventricle. By doing this, the heart’s chamber is made smaller and thus it can contract more effectively to pump more blood.

The image A below shows the heart before surgery  

The image B shows the heart after surgery

 

Initially, the aorta of the hollow heart patient is clamped. Then, with the help of a heart lung machine, the heart persists to function. Then after removal of the block in the left ventricle, the surgeon again closes the heart with the help of a few stitches. This process is done by surgeons with vast experience. However, after carefully completing with the stitches, the heart lung machine is then removed. The Batista procedure is used for patients whose heart muscles have been stretched or weakened by some disease, such as infection or inflammation which has led to congestive heart failure.  

The Batista's operation procedure has a high death rate of about 20 percent in the first post-operative month and 20 percent in the rest of the year making a total of about 40 percent. There were debates whether to continue the use of this procedure or not. Though, the Batista procedure seemed to show potential at first, it was later found to have little benefit and more risks which is why today, the Batista procedure is not a recommended treatment for dilated cardiomyopathy. Another reason for why this procedure is not used is that, suppose if the heart fails to respond to conventional therapy then, the patients will be at an even higher risks to suffer from severe heart failure.

Coronary Artery Bypass Grafting

Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease. 

CHD is a condition in which a substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. 

Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. If the blockage is severe, angina (an-JI-nuh or AN-juh-nuh), shortness of breath, and, in some cases, heart attack can occur. (Angina is chest pain or discomfort.) 

CABG is one treatment for CHD. During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. 

This creates a new passage, and oxygen-rich blood is routed around the blockage to the heart muscle. 

Soalan PBL bersama Prof Dr Khatizah Haida bt Ali

Tetralogy of Fallot

Tet; TOF

Tetralogy of Fallot refers to a type of congenital heart defect. Congenital means present at birth.

Causes, incidence, and risk factors

Tetralogy of Fallot is classified as a cyanotic heart defect because the condition causes low oxygen levels in the blood. This leads to cyanosis (a bluish-purple color to the skin).

The classic form of tetralogy includes four related defects of the heart and its major blood vessels:

• Ventricular septal defect (hole between the right and left ventricles)
• Narrowing of the pulmonary outflow tract (the valve and artery that connect the heart with the lungs)
• Overriding aorta (the artery that carries oxygen-rich blood to the body) that is shifted over the right ventricle and ventricular septal defect, instead of coming out only from the left ventricle
• A thickened muscular wall of the right ventricle (right ventricular hypertrophy)

At birth, infants may not show signs of cyanosis. However, later they may develop sudden episodes (called "Tet spells") of bluish skin from crying or feeding.

Tetralogy of Fallot is rare, but it is the most common form of cyanotic congenital heart disease. Patients with tetraology of Fallot have a higher incidence of major non-heart congenital defects.

The cause of most congenital heart defects is unknown. Many factors seem to be involved.

Factors that increase the risk for this condition during pregnancy include:

• Alcoholism in the mother
• Diabetes
• Mother who is over 40 years old
• Poor nutrition during pregnancy
• Rubella or other viral illnesses during pregnancy

There is a high incidence of chromosomal disorders in children with tetralogy of Fallot, such as Down syndrome and DiGeorge syndrome (a condition that causes heart defects, low calcium levels, and immune deficiency).

Symptoms

• Clubbing of fingers (skin or bone enlargement around the fingernails)
• Cyanosis, which becomes more pronounced when the baby is upset
• Difficult feeding (poor feeding habits)
• Failure to gain weight
• Passing out
• Poor development
• Squatting during episodes of cyanosis

Signs and tests

A physical examination with a stethoscope almost always reveals a heart murmur.

Tests may include:

• Chest x-ray
• Complete blood count (CBC)
• Echocardiogram
• Electrocardiogram (EKG)
• MRI of the heart (generally after surgery)

Treatment

Surgery to repair tetralogy of Fallot is done when the infant is very young. Sometimes more than one surgery is needed. When more than one surgery is used, the first surgery is done to help increase blood flow to the lungs.

Surgery to correct the problem may be done at a later time. Often only one corrective surgery is performed in the first few months of life. Corrective surgery is done to widen part of the narrowed pulmonary tract and close the ventricular septal defect.

Expectations (prognosis)

Most cases can be corrected with surgery. Babies who have surgery usually do well. Ninety percent survive to adulthood and live active, healthy, and productive lives. Without surgery, death usually occurs by the time the person reaches age 20.

Patients who have continued, severe leakiness of the pulmonary valve may need to have the valve replaced.

Regular follow-up with a cardiologist to monitor for life-threatening arrhythmias (irregular heart rhythms) is recommended.

Complications

• Delayed growth and development
• Irregular heart rhythms (arrhythmias)
• Seizures during periods when there is not enough oxygen
• Death

Calling your health care provider

Call your health care provider if new unexplained symptoms develop or the patient is having an episode of cyanosis (blue skin).

If a child with tetralogy of Fallot becomes blue, immediately place the child on his or her side or back and put the knees up to the chest. Calm the baby and seek medical attention immediately.