KOREKSI BEDAH

KELAINAN JANTUNG BAWAAN

Dr.juli ismail SpB.SpBTKV
Bag.bedah RS M Jamil
 PRA BEDAH

• Diagnosa DIAGNOSA
• Tampilan klinis
• Indikasi

• Toleransi

• Timing

• Teknik
• Sianosis
• Low out put state
• Edema paru
 TEKNIK
• CARDIO PULMONARY BY PASS (CPB)
• Deep hipothermia  20-25 o C
• Total circulatory arrest

• MYOCARDIAL PROTECTION
• Intermitten Cardiophlegic potassium 15-35 mEq/L
• Crystalloid/blood
• 15-20 menit atau elektrical +
• TOPICAL HIPOTERMIA
 DASAR PEMBEDAHAN
• Anatomi jantung

• chamber’s

• RA – LA
• RV – LV
• PA - AO
 ANOMALI

complex tapi mudah dimengerti

• Kelainan

hole
stenosis
ggn letak ruang
(concordant/discordant )
BEDAH JANTUNG

Closed heart surgery

PDA,SHUNTING,PA BANDING

Open heart surgery

HEART LUNG MACHINE

HEART LUNG MACHINE
 SHUNT PROCEDURE
• SISTEMIK

• PULM.ART

konserpatif

usia / bb optimal
untuk operasi defenitif
 BLALOCK TAUSSIG shunt
(BT shunt)

• A.Subclavia

• PA kiri
 WATERSTON shunt

• Ao

• main PA
 PA BANDING
• VSD BESAR

• SINGLE VENTRICLE

• TGA dengan VSD

• COARCTATIO AORTA
dengan VSD

• PDA besar
 Total anomalous pulmonary venous
connection (TAPVC)
• Normal :

• v.pulmonal  atrium kiri

• Anomali

Atresia LA / mitral
v.Pulmonal  ?
 *supra cardiac

• v.cava sup
• v.azygos
 *cardiac

• RA
• Sinus coronarius
 *infra cardiac

• v.porta
v.cava inf
 KOREKSI

• ANATOMI
 ASD
• flow ke PA besar
• (l to r shunt )

• Problem :
• Eisenmenger ( r to l shunt )

• Usia ideal
• sebelum pubertas

• TEKNIK
• Open heart
• Asd closure dengan patch pericard.
 AVSD
ASD + connection TV-MV / RV-LV

TEKNIK

Open heart
Rekonstruksi katup
Asd closure
dan
Vsd closure
 TRICUSPIDAL ANOMALY
• ATRESIA

Palliatif FONTAN op.

• EBSTEIN ‘S

annuloplasti
 VSD
• PROBLEM
• posisi katup.

• Indikasi
• lebar
• gagal obat

• Teknik
• Open heart
• Vsd closure dengan sintetis
• Dacron/goretex patch.
 TETRALOGY FALLOT
• VSD,
• OVERIDING AORTA
• STENOSIS PULMONAL,
• HIPERTROPI VENTRIKEL KANAN

• Palliatif
• shunting

• Defenitif ;
• usia < 1 th
• Open heart
• Koreksi stenosis PA
• vsd
• Hipertropi r v
 TRANSPOSITION GREAT ARTERY
TGA
• Palliatif
• atrial septectomy

• Defenitif
• MUSTARD’s
• SENNING’s
• ANATOMYCAL correction
 TRUNCUS ARTERiOSUS & PDA

• TA
• koneksi Ao-Main AP
• Open heart

• PDA
• Ao – AP ki
• Closed heart
• Ligasi.
 COARCTATIO AORTA

• Sempit Ao descendens

• Open heart

• angioplasty