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Morning Report

Morning Report. October 7, 2010. Complications of Cardiac Surgery. Morbidity and Mortality rates have decreased Better techniques Prevention of infections Better knowledge of complications Three time periods Immediate post-op Short-term post-op Long-term post-op. Cardiac Surgery.

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Morning Report

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  1. Morning Report October 7, 2010

  2. Complications of Cardiac Surgery • Morbidity and Mortality rates have decreased • Better techniques • Prevention of infections • Better knowledge of complications • Three time periods • Immediate post-op • Short-term post-op • Long-term post-op

  3. Cardiac Surgery • Immediate post-op • Intubation • Anesthetic agents • Blood loss • Fluid management • Length of time on bypass

  4. Cardiac Surgery • Immediate post-op • Respiratory • Intubation • Vocal cord damage • Secretions • Low cardiac output • Tachycardia, decreased UOP, decreased BP • Fluid vs pump failure • Arrhythmias • Any surgery near the atria • Tachycardia • Bradycardia

  5. Cardiac Surgery • Immediate post-op • HTN • Coarctation or PDA • Managed medically but usually short lived • Coarctation • Postcoarctation syndrome • Abd pain, infarction of bowel • Chylothorax • Creamy fluid in chest tubes, high fat content, negative culture • Damage to thoracic duct • Modify diet – low fat • Portagen for babies • May reside on own or require chest tubes or surgery

  6. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Febrile illness • 7-10 post op day • Pericardial and/or pleural reaction • Children>Infants • Extensive procedures • Most cases are mild • May only be found on post op echo as an effusion

  7. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Symptoms • Fever into second post-op week • Or may return in 2nd or 3rd week • Anterior precordial chest pain • Increases on deep inspiration • Increases when supine • Intermittent friction rub

  8. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Lab findings • Increased WBC • Left shift • Increased ESR • ECG • Flattened or inverted T waves • Echo • Pericardial effustion

  9. Cardiac Surgery • Short-term post-op • Postpericardiotomy Syndrome • Usually self limited • Persistence of effusion is concerning • Tamponade • Muffled heart sounds, pulsusparadoxus, JVD • Antiinflammatory agents • ASA or steroids

  10. Cardiac Surgery • Long-term post-op • Infective Endocardits

  11. Cardiac Surgery • Long-term post-op • Infective Endocardits

  12. Cardiac Surgery • Long-term post-op • Arrhythmia • Sick sinus syndrome • Syncope • PVCs • Need further monitoring • CHF • Condition not relieved • Injury to a critical area • High cardiac burden before surgery

  13. Cardiac Surgery • Long-term post-op • Valvular regurgitation • Even with good initial results • May need second surgery • Aortopathy • Progressive dilation of ascending aorta • Coarctations • Close follow up

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