Tetralogy of Fallot (TOF) is the most common cyanotic heart disease with anomalies consist of: ventricular septal defect (VSD), overriding aorta, pulmonary stenosis and hypertrophic of the right ventricular. It also has various anomalies type such as TOF with absent pulmonary valve, TOF with pulmonary atresia, TOF with atrioventricular septal defect, TOF with coronary artery anomalies, etc which will be discussed in detail. Proper diagnosis is required when dealing with the TOF continue with radiological examination. Adequate history taking and correct physical examination are necessary in dealing with congenital heart defects, especially TOF case. In this overview, we also discuss about the comprehensive management, from tet spell management, palliative management of TOF that required shunt with various technique, and surgical total corrective of TOF with many approach such as transannular accompany with right ventriculotomy or transatrial with transpulmonary or beating heart surgery technique to prevent reperfusion injury complication.
A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019. It has spread rapidly from China to worldwide. The COVID-19 pandemic of 2020 posed a historic challenge to healthcare systems around the world, healthcare systems needed to consider providing clinical services to other patients in need. The specialty of general thoracic surgery includes the management of serious diseases such as chest wall congenital anomaly, lung cancers, esophageal cancers, mediastinal tumor, chest wall infection, and trauma. Thoracic surgery is one of high risk procedure in this pandemic, however, a high level of evidence supports the surgical management of potential patients with thoracic disease and anomaly is still lacking. Critical determinants of robust thoracic surgery service provision are pre-existing plans for epidemic response. "Flatten the curve" as an aggressive action is needed. Prioritizations of thoracic surgery cases are needed to differ between elective and emergency cases to limit any contamination. Before surgery, important pre-operative assessments were conducted aims to identify patients' high risk and adjust the procedure. example of a recommendation, if urgent / emergency surgery with symptoms clear clinical pneumonia or rapid test (+). The lessons learned can apply to the other areas during this pandemic, and the world, in preparation for the next one.
An abdominal aortic aneurysm (AAA) is defined as an abnormal dilatation of the abdominal aorta more than 50% of its diameter. The aortic wall continues to weaken and become unable to hold the forces of the luminal blood pressure, resulting in progressive dilatation and rupture. The rupture of the aneurysm wall is influenced by several factors, such as the aneurysm size, expansion rate, continued smoking, and persistent hypertension. The AAA is a common degenerative condition with high mortality in older people. The AAA increases these last two decades. It is occurring in 7-8% of men at the age of over 65 years old. The disease prevalence is six times higher in men than in women. It is also increasing dramatically by the presence of the following factors: age older than 60 years old, smoking, hypertension, and ethnicity. Repair of large or symptomatic AAA by open surgery or endovascular is recommended, but not significant in the small aneurysm. ___________________________________________________________________________
Wound healing is a series of biophysiological processes, beginning with tissue injury, and ending with repairs from the wound tissue itself to a complete state consisting of several phases including inflammation, proliferation and remodeling. Every process of wound healing always leaves a scar. Hypertrophic and keloid is a product of abnormal wound healing. This abnormal scar formation is influenced by several factors, one of which is the wound stress. A tension that is too large in a wound will cause a hypoxic state in the wound itself. This hypoxic state will cause recurrent inflammation which leads to abnormal scar formation. One of abnormal scars formation prevention is reduction in wound tension. Reduction in wound tension reduce the inflammation process.
Coronavirus Disease 2019 (COVID-19), which is caused by the SARS Coronavirus 2 (SARS-CoV-2), has affected over 200 countries worldwide. First case of COVID-19 was found in Wuhan, China, precisely around December 2019. COVID-19, especially in those with underlying health conditions or comorbidities, has an increasingly rapid and severe progression, often leading to death. This virus is a single-strand RNA coronavirus, binding the angiotensin-converting enzyme 2 (ACE2) receptor which enters human cells. Coronavirus disease has been reported to affect cardiac and vascular organs. cardiomyocyte death and inflammation are results of a direct mechanism that involves viral infiltration into myocardial tissue. Some cardiovascular manifestations of myocardial injuries associated with COVID-19 are arrhythmias, myocardial infarction, heart failure, and elevated biomarkers (cardiac troponin I and brain-type natriuretic peptide). Some of this manifestation requires immediate intervention or surgery. Criteria are needed for hospitals or institutions that mostly maintain cardiac surgery services and surgery-urgent patients depending on severity of the disease and hospital resources. These criteria also limit the risk of exposure to patients and healthcare workers and allocate resources appropriately to those in greatest need. This paper aims to share our discussion and give an overview of patients undergoing cardiac surgery, providing clinicians with recommendations to triage and plan these procedures during the COVID-19 outbreak effectively.
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