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Samenvatting Ingrepen voor ischemisch hartlijden
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Samenvatting Keuzevak Hartchirurgie
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INGREPEN VOOR ISCHEMISCHHARTLIJDEN
- Chirurgische revascularisatie; CABG
- Anatomie:
o Rechtsdominant: infralateraaltakken van de rechtercoronair
(posterior descending artery)
o Linksdominant: posterior descendens tak van de a. circumflex (15%)
- Onderzoeken:
o EKG: toont plaats van ischemie
o Echo toont dysfunctie
o Coronaire angiografie: toont de letsels! (catheterisatie)
o CT : merker om coronair lijden aan te tonen, goed voor screening,
maar niet om revascularisatie te plannen
- Eerste poging: Wineberg procedure: a. thoracica doorheen een tunnel
trekken tot bij het hart om daar te hopen dat er nieuwe zijtakjes worden
gevormd
- Coronaire end-arterectomie: slechte resultaten (openen en plaque uithalen
+ patch innaaien)
- CABG: greffe van proximale aorta ascendens tot zijdelingse anastomose op
de coronair (overbrugging zieke stuk). Soorten:
o A. thoracica interna (zeldzaam: a. radialis, a. gastroepiploica)
Proximale deel kan je laten zitten, moet je niet aan de aorta
hechten
Heel goede patency rate
o VSM
Heeft grotere diameter
Vene: wand is dunner vaak reactieve endotheelproliferatie
= predilictieplaats voor nieuwe atherosclerose
o Off pump CABG: bijkomende materialen om het hart te visualiseren
en stabiliseren
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