1ST ANNUAL CLINICAL MEETING DIVISION OF CARDIAC SURGERYShisong Cardiac CenterOrganizing Committee: Mr. Marcel Fanka Tanlanka

Program(5 minutes for each presentation)

Moderators: Dr. Jacques Cabral Tantchou Tchoumi; Dr. Jean Claude Ambassa

The Role of Extracorporeal Circulation in Cadiac SurgeryMr. Fanka Tanlanka Marcel ; Discussants: Sr. Juliet Berinyuy; Hilary Ayong

Surgical Techniques for the Establishment of Extracorporeal CirculationMr. Julius Peter Mbiydzenyuy ; Discussant: Mr. Roger Tachea

The Use of Inotropes in Cardiac SurgeryMr. Thierry Yunishe ; Discussant: Sr. Ruth; Mr. Gerard

Management of Cardiac Arrythmias after Open-Heart SurgeryMr. Justin Bika; Discussant: Sr. Isodora

One -Year Experience in Cardiac Surgery at The Shisong Cardiac CenterDr. Charles Mve Mvondo ; Discussants: Dr. Jean Claude Ambassa, Dr Jacques Cabral Tantchou Tchoumi

Open Discussion and Cardiologists Point of View

ConclusionsDr. Charles Mve Mvondo

Thursday 19, December 2013; 07.30 to 8.30 am; Relax Area, ICU. Cardiac Center.

The Role of EThe Role of ExtraxtraCCorporeal orporeal CCirculation in Cardiac Surgeryirculation in Cardiac Surgery

Presentation: Fanka Tanlaka MarcelPresentation: Fanka Tanlaka Marcel• Discussant : Sr Juliette BerinyuyDiscussant : Sr Juliette Berinyuy• Contributions : Ayong Hilary GahContributions : Ayong Hilary Gah

What is Extracorporeal Circulation ?

A medical equipment that provides Cardiopulmonary bypass, (temporary mechanical circulatory support) to the stationary heart and lungs)

• Heart and Lungs are made “functionless temporarily” , in order to perform surgeries

The Physiology of ECC

What key things does ECC do during Cardiac Surgery ?

• Provides bloodless field for the Surgeon• Artificial Pump• Artificial lungs• Myocardial protection• Organs function• Blood gas, chemistry , anticoagulation

state

“to return the patient to the normal

physiologic state in spite of the insults that may transpire’’

Goal of the Perfusionist

Factors Inspiring Evolution• Coagulation Disorders• Biocompatibility• Infection Control• Blood transfusion• Haemolysis• Biochemistry & BGA• Post operative complications

Future Prospects1. Material science2. Pumping systems3. Oxygenating systems4. Monitoring ( computer Science)5. Blood Salvaging6. Circulatory assistance7. Artificial heart ( remains the ultimate goal

of the Bioengineer)

Thanks for your very fervent attention...

Surgical Techniques for the Establishment of

Extracorporeal Circulation

Mr. Julius Peter Mbiydzenyuy ; Discussant: Mr. Roger Tachea

Introduction • Most operations require the use of CPB. • Basic techniques of arterial and venous

cannulation are similar in both CHD & adult cardiac surgery.

• Some modifications are necessary to accommodate the multiple anatomical variations that may be encountered in congenital defects

HEART-LUNG MACHINE

The General Idea:-

Axillary, Femoral

The procedure• Collection of Cannulae • Reception and fixation of CPB Circuit

to the Sterile camp• Standard median sternotomy or

Thoracotomy• Purse Strings• Cannulation

Types of Cannulation

• Arterial Cannulation– Aortic – Subclavian– Femoral

Venous cannulation

• Monocaval (Double stage)• Bicaval

– IVC– SVC

• Tricaval in rare cases of CHD– IVC– SVC– LSVC

• Femoral

Cannulation for Cardioplegia

• Antegrade – Ascending Aorta – aortic root

• Retrograde – Coronary sinus• Selective - Coronary ostia

Cannulation for Heart Venting

Left Heart Venting

Aortic Vent

Conclusion

The techniques which are described in this presentation are used routinely in our institution in all patients, whatever the complexity of the pathologies and the age of the patients.

Thanks for your very fervent attention

The Use of Inotropes in Cardiac Surgery

Mr. Thierry Yunishe ; Discussant: Sr. Ruth GOOH; Mr.

Gerard Kindzeka

The use of Inotropes in Cardiac Surgery

• Drugs that affect the force of contraction of myocardial muscle

• Positive or negative

• Term “inotrope” generally used to describe positive effect

Main Goal

Tissue perfusion & oxygenation

Basic principles - Inotropes

MAP = CO x SVR

CO = HR x SV

Preload Contractility After load

+VE INOTROPES

Drug Classification

• Sympathomimetics– Naturally occurring– Synthetic

• Other inotropes– cAMP dependent– cAMP independent

Sympathomimetics

• Naturally occuring– Epinephrine– Norepinephrine– Dopamine

• Synthetic– Dobutamine– Dopexamine– Phenylephrine– Metaraminol– Ephedrine

Other inotropes

• cAMP dependent– Phosphodiesterase inhibitors

• cAMP independent– Digoxin– Calcium

Phosphodiesterase inhibitors

• Non-selective– Aminophylline

• Selective • Enoximone• milrinone • Levosidan

Receptor Sites• Adrenergic

Receptors

• Alpha 1• Alpha 2• Beta 1• Beta 2

• Dopamergic receptors

• D1• D2• D3• D4• D5

Main classes of Adrenoceptor

receptors 1

• Located in vascular smooth muscle• Mediate vasoconstriction

2

• Located throughout the CNS, platelets• Mediate sedation, analgesia & platelet

aggregation

Main classes of Adrenoceptor receptors

1• Located in the heart• Mediate increased contractility & HR

2• Located mainly in the smooth muscle of bronchi• Mediate bronchodilatation• Located in blood vessels

– Dilatation of coronary vessels– Dilatation of arteries supplying skeletal muscle

Epinephrine (Adrenaline)• Stimulates & receptors

– Predominantly effects at low doses and effects at high doses

• Clinical uses– Cardiac arrest– Anaphylaxis– Low cardiac output states– Upper airway obstruction– Combination with local anaesthetics

• Side effects– Dysrhythmias– Increase in myocardial oxygen consumption

Norepinephrine

• Predominantly stimulates 1 receptors• Most commonly used vasopressor in

critical care• Very potent• Administered by infusion into a central vein• Uses

– Hypotension due to vasodilatation– Septic shock

Dopamine

• Effect dose dependent– Direct

• Low dose - 1

• High dose - 1

– Indirect• Stimulates norepinephrine release

• D1 receptors– Vasodilatation of mesenteric & renal circulation

Dobutamine

• Synthetic• Predominantly 1

• Small effect at 2

• Uses– Low cardiac output states– Cardiogenic shock

Thanks for your kind attention

Management of Cardiac Arrhythmias after Open-Heart

Surgery

Mr. Justin Bika; Discussant: Sr. Isidora Jaff

• SA Node• Inter-nodal and inter-atrial pathways• A-V Node• Bundle of His• Perkinje Fibers

Conduction System

• Normal– Heart rate = 60 – 100 bpm– PR interval = 0.12 – 0.20 sec– QRS interval <0.12– SA Node discharge = 60 – 100 / min– AV Node discharge = 40 – 60 min– Ventricular Tissue discharge = 20 – 40

min

Physiology

• Cardiac cycle– P wave = atrial depolarization– PR interval = pause between atrial and

ventricular depolarization– QRS = ventricular depolarization– T wave = ventricular depolarization

Physiology

Arrhythmias

• Definition: Heart rhythm problems (arrhythmias) occur when the electrical impulses in your heart that coordinates your heartbeats don't function properly, causing your heart to beat too fast, too slow or irregularly.

Arrhythmias

● Arrhythmias may cause sudden death, syncope, heart failure, dizziness, palpitations or no symptoms at all.

● There are two main types of arrhythmia:bradycardia: the heart rate is slow (< 60 b.p.m). tachycardia: the heart rate is fast (> 100 b.p.m).

Pathophysiology of Arrhythmias.• Arrhythmias:- Heart is beating too fast, - Heart is beating too slow, - Heart is beating irregularly.• Two types of arrhythmias; Bradycardia & Tachycardia• Bradycardia; Heart is beating too slow. Two causes: 1) SA node is either slowed or absent. 2) Blockage of conduction at the AV node 3) types of Heart blocks)• Tachycardia; Heart is beating too fast, Causes: 1) Increased Pace maker Activity from the SA node 2) Re-entry Tachycardia 3) Delayed Repolarization

P & P Ward experience & Mgtw.r.t types arrhythmias .

• Sinus node Dysrhythmias:• Sinus bradycardia• Sinus tachycardia• Atrial Dysrhythmias :• Premature Atrial Complex (PAC)• Atrial Flutter• Atrial fibrillation• Junctional dysrhythmias• junctional rhythm• Ventricular Dysrhythmias:• Premature Ventricular Complex (PVC)• Ventricular Tachycardia• Ventricular Fibrillation• Ventricular Asystole• Conduction Abnormalities:• First-Degree Atrioventricular Block• Second-Degree Atrioventricular Block, type 1• Second-Degree Atrioventricular Block, type 2• Third-Degree Atrioventricular Block

THANKS FOR YOUR FERVENT ATTENTION

One -Year Experience in Cardiac Surgery at The Shisong Cardiac Center

Dr. Charles Mve Mvondo ; Discussants: Dr. Jean Claude Ambassa, Dr Jacques Cabral

Tantchou Tchoumi

Open Discussion

1. Cardiologists Point of View

2. General Discussions

Conclusion “CARDIAC SURGERY CAN BE SIMPLY AWEFULLY CARDIAC SURGERY CAN BE AWEFULLY SIMPLY”

Thank you so much. Happy Christmas & prosperous New Year 2014

Let’s Have a common Picture outside

to commemorate this day