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Hello, everyone. Welcome. Welcome. Um, can you please confirm if you can hear me clearly, Just drop a response and the chat, just to be sure that everyone can hear me clearly. Okay. Okay. I've seen a few. Yes. Is okay. So I would go ahead. Thank you very much for joining us today. Um, my name is, um uh You wanna Femi Akhund? I I go by in infamy. Um, uh, clinical, fellow and cardiothoracic surgery at your property hospital. And, um, I'll be taking this session today. Um, So, um, just a brief introduction to what this, um, teaching session is about, um this is being hosted by, um, UK cause, which is the UK collaboration of Aspire Women's Surgeons. But the teaching is open to everyone, not only women, female doctors, and, um, it's going to involve a series of teachings. Um, about 5 to 7 sessions. Uh, two modules, one in cardiac surgery and the other in, um, thoracic surgery. Um, so this is the first, um, this is the first session for the first model, and it's going to be discussing just a general overview of the anatomy of cardiac structures. Um, I know we all have been taught, um, the anatomy of the cataracts of cardiac structures in school. And we're we have we. But this is just going to be a broad overview, a refreshing of our minds. And this session is open to both, um, um, final year medical, um, students and Junior Doctors Foundation, one year doctors and junior doctors that probably have an interest in pursuing cardiothoracic surgery. And, um, we like to just have a refreshing of what? The, um the common cardiac conditions. Cardiac anatomy, cardiac physiology. Um, yeah. So that's what we're going to be discussing today. Um, so, um, the outlined for today the objective of today. Um, so we're going to be, um, describing the functions and structures of the art and the pericardium, and we should be at the end of this session. Um, we should be able to have a clearer understanding of this, um, a clear understanding of the electrical conduction, um, of the arts and also of the great vessels, which are part of the, um, cardiac structures. Um, so they said, um, the outline. So I'm going to do a brief introduction. They were going to move from outwards inwards. So we're going to start with the thoracic wall. We're not going to die. Die very deep into the thoracic wall because in subsequent sessions, when we'll be discussing the anatomy of thoracic structures, um, there the thoracic wall. When we are discussing the ribs, the clear and everything will be discussed more in details. That is where it's more relevant for this session will be concentrating more on the, um, anterior, um, thoracic wall majorly on this turnem, which is the most relevant aspects in cardiac surgery. And then after, um discussing that we're going to move on to discuss the mediastinum and the ministerial structures and then focus on the pericardium, which is where we are going to the heart in the pericardium, the great vessels. And, um, we're just going to a conclusion. So this should just, um, this session should just be about for five minutes, and then we'll have the last 15 minutes for questions and, um, and answers. Okay. Mhm. Okay. So, as I said, I've I've given a brief introduction to the cost. Um, it's been posted by UK calls, and the sessions are going to be, um, are going to be led um are going to be taught by, um, cardiology. Um, doctor, um, doctors and training radial. Um, radiology doctors in training characteristics such as training, um, or non training. Also with jobs. Um, between non training rules. Also, um, and they're just going to give a view of review a series of the sessions we're going to talk about, um, imaging, um, cardiac comedians out to have to read CT scans out to read E C g. S. Um, we're also going to talk about common, um, cardiothoracic procedures like, um, the bypass graft. Um, cardiopulmonary bypass, which is one major aspect of cardio to asic surgery. Um, when when operating on a, uh, when trying to operate on a bloodless field. Um, we're also going to, um, discuss, um, operative complications. Um, post operative complications perioperative management of cardiac patient's. And hopefully with this series of, um, lectures. By the end of the model, we would have a wider understanding, better understanding. And, uh, hopefully we will have been refreshed on on some of these on some of these topics, and we'll be able to, um, we'll be able to maybe teach it later on also. Okay, so So it's a way of introduction. As I said earlier, um, we are going to be looking at the, um, thoracic war initially. And then we'll move on to the peri, um, to the mediastinum. Look at the medicine wheel structures. The great vessels in the medicine. Um, Then move on to the pericardium, look at and then move on to the art. And when we are talking about the art, then we'll talk about the, um the structure of the art, the conductive conductive system in the arch development of the art and what have you. Okay, So as I said, uh, we are going to be focusing majorly on this tunnel, um, in the thoracic wall. So, um, as we all know, this turnem is the flat bone, um, and cereal located and serially, um, and you to relax. And, um, it's major function, basically is, um, the protection of, um, structures in the heart. So we know that the, um, this time, um, is divided into two divided into the upper part. The lower parts by the, um, standard angle just here. And the standard anger is at the T four level, which divides the, um, the sternum into the, uh into which also demarcates the, um, division of the MEDIASTINUM into the superior and the inferior mediastinum. So we have the super sternal notch just at the top. Um, we have the, um, starting angle, also known as the, um, angle of flu. And we have the xiphoid process. Um, why the sternum is important in cardiac surgery, Basically because, um, for in part Amina's turn out to me, which is one of the most commonly performed procedures in cardiac surgery to do, is turn it to me. If you want to do a valve repair, you want to do a valve replacement you want to do as transplant. You want to do basically whatever procedure you want to do in cardiac surgery? Uh, you need to do most of the time you need to do is turn it to me, which is basically, um, dividing this turn up at the midline. And, um, in order to do this, you must be able to, um, clearly demarcate the midline from the chest. So, um, are you able to for to, in order to perform a sternotomy for instances, um, your squabbling in surgery, um, you want to locate your super sternal notch, and you want to locate your side buoyed process, um, down below and, um, draw an invisible line or a line to mark the line of your incision You in order to place it directly at the center. This is because most of the time, um, standard infections are very common. Um, post operatively. And one major cause of this is because the line of incision, um, divide one doing external to me. It doesn't it deviates from the midline. We know that the midline is the one of the most, um the least. Um, where blood supply is less is least supplied. And so if it's directly at the midline, it's, um it's it's, um it's it's basically improves chances, uh, reduce the chances of infection and stuff like that. So, in order to, um, but do a very successful sternal to me, um, you need to divide the sternum, um, at the midline So directly from this personal notch, um, to the xiphoid process, uh, most of the time during, um, in adults, the cyber process is basically it's a Catholic, but it's already calcified and very ad, and so usually it can be taken out of there in surgery, and so you need to, um, adequately, be adequately able to, um, recognize, Recognize it? I think, uh, everyone of us should be able to look at our sternal notch also, uh, versus and yeah. So that's the relevant of, um, talking about this sternum, Um, in cardiac surgery. Basically. Okay, So the upper part of the, um, send, um, is called the MANOGRAM. And we have the body. Then we have the safer process, and we have the postal notches. We have the, um the postal, um, cartilage is, um, connect connects to the And then, of course, we have from the the ribs and the and severe ribs, the posterior ribs. And, yeah, so moving on from this, and, um, we will just like Okay, um, so that's the the bony structure. That's the skeletal help act that's the relevant. And that's relevant part of the thoracic cage that is most relevant at this point. This tunnel, um, the other parts, the Reeves, the intercoastal muzzles, every other part will be discussed more in detail in the other sessions. And now we're going to move on to the mediastinum. So also the pleural space is the lungs, and those other parts will be discussed in the other sessions where they'll be discussing the, um, anatomy of touristic structures. And for now, this session we're going to be deconstruct waiting on the mediastinum, uh, the pericardium and majorly the art. So, um, the mediastinum we know the main destiny. Um, as the um is the signal cavity. It's the basically the sack of the center, uh, at the center of the art at the center of the chest in between both plurals in between both lungs. And so it's, um, superior early. It's, um, bounded by the Jurassic in Let's, um, inferior Early, bounded by the diaphragm and at the side is bounded by the, um by the the lungs basically, and the mediastinum is, um, divided into two divided into the superior and the inferior intestinum. I mentioned earlier that the sternal angle the angle of Louis, um is the D marketing, which is the level of the t four. It will demarcate the medicine, um, into, um superior and inferior molesting. Um um, the superior medicine, um, contains the structures and then inferior medicine. Um also contains structures, but interestingly, the inferior medicine, um, is then, um, more subdivided into anterior middle and posterior mediastinum, which I have, um, specific structures located located in them, Um, the, um, superior in Destin. Um, uh, as I said, um, bounded up by the traffic and let upwards superior early. And the t four the level of the t four, um, is the end of the, uh, superior intestinum. Um, I just we like, uh, some responses because it's almost as though I'm talking to myself here, Um, could, uh, at the level of the t four. Where the of the sternal angle could someone anyone just people just, um so that this could be a more interesting session? Could you just, um, put on the charts? Um, the structures that are located at the T four of the mediastinum? If if you have any ideas, just, um I could put some ideas. I'll be waiting to get some responses. Okay. Well, uh, with that, um, yes. So the so superior superior? Uh, um contains this. It contains the, um, vagus nerves. Um, phrenic nerve is the superior. Venal. Covered you sofa goes the trachea, the thoracic door docked. It contains a lot of, um, a lot of, um a lot of structures basically and importance of these characteristics. Surgeries, Um, at the point of doing, uh, turning to me when you open up the chest, the level of the sternal angle, the level of the sternal angle that is the t four. It helps you gives you a clear picture of, um, where you are hat in the in the arts, in in the arts, basically in the in the mediastinum. So it and it helps you to clearly at that level. So at the level of the medicine, um, their t four, that is where you get the you find the aortic arch. That is where the, um, the tigers vein drinks into the SBC. And having all these an atomic at the back of your mind will help you clearly locate the structures. Because when you open up your chest, basically, everything gets it's not as as clearly seen as it is on the picture right here where everything looks so well demarcated, but it doesn't happen like that in your life. But having these, um, anatomical, um, landmarks in your mind, um will help you to correctly locate some vessels there. I'm still waiting on some responses. Uh, got endorsements. Yeah, that's fine. Um, so, um, the inferior maddest in, um, coming to the inferior medicine. Um, we have the anterior divided into anterior. Um, posterior medial anterial. You just made up of, uh, the extension of the thymus made up of fact, which is just the level directly beneath the sternum and 11 important thing to note here is one other, uh, common. Um, cardiacs. Uh, cardiac surgery that is usually done is, um, subside. Avoid time. Timex to me where the time was has been removed. And for this type of surgery. You good. You, You You, um you assess the superior mediastinum very the anterior, Majesty. Um, so you're able to either remove the scifi process or lift it up and, um, able to assess the thymus gland and those anterior structures basically usually very fatty structures made up of lymph nodes also, that can be taken our sense to turn to the lab, then, um, the media, the middle of my destiny, which is, um, the most important part is where the axis where the pericardium is located, which surrounds the arts and contains a lot of, um the great the great vessels. The sec, the attic, uh, the ascending aorta, the pulmonary trunk and the rest of them. And then we have the posterior where we have the truck here, the esophagus, and so thoracic doctors and, um, some other vessels and nerves Vagus naval. So it's located, um, at the posterior. So having this landmarks not, um, just behind the pericardium. Then you have your track here you have yourself because you have some veins. You have some nerves. But as the pericardium, um, the middle the pericardium encloses the arts and the the, um the beginning of the of the great vessels at that point in time. So, uh, when you put your hand just behind your pericardium, then you should be able to fill your track. Here, you'll be able to feel posterial posterior structures. So this also is really is very important, uh, during cardiac surgery, because, uh, most of the time, you want to be able to, uh, lift the pericardium of the posterior, um, of the of the posterior majestic medicine. Um, to be able to make sure that you are not going to damage structures behind it doing surgery. Um, okay. I think, um, this. Okay, so I talked about the t four level. Um, there are quite a number of things that this is one of the things that, um, we learnt where we are in school at the T four level. What, Of course, at the T four level. Um, so we have the aortic, um, t four level. It gives off the branches. It gives us these branches. We also have the bifurcation of the pulmonary trunk at the T four level. We have the bifurcation of the track here at the T four level. We have the drainage of the Jurassic docked, um, into the into the drug. Levine at the T four level. We have the drainage of these. I got vein into the, um as we see adity for them. So quite a number of structures at that level, the level of the standard angle takes place there. And this this gives knowing this gives you a perspective of where you're where you're at, um, in the where you're at, basically, in the in the pericardium. Basically, it helps you to, um, correctly locate structures, as as I've mentioned earlier Okay, Um, so I just wanted, uh So this is something that we'll really be helpful is one of those questions that you could just asked, uh, asked inward round that mentioned, um, for relevance, um, structures at the T four level, uh, five or 10 or 10 of them. You should be able to quickly think of something and yeah, it's, you know, it's surgery. Anatomy is really very important. It's, um it's basically the bulk of surgery. It guides your decision making. Basically, when you're doing surgery, and so it's always important to have as much detail as much information about what you're doing at the back of your mind because it will guide your process. It will guide your thought process. And it's a guide decision making. Um, in surgery, of course, there are always variations between individuals, but this is, um, the majority of cases that that, of course, in in that level. Okay. Uh, OK, enrichments. Is that the chance you take, uh, the current? Okay. Um, so So I have the, um uh of the, um um in the pericardium. Also, the pericardium also, um, encloses the the great vessels. And I just want um, if it's okay, um, I'm going to Can Can can you guys see my casa on the screen? Can you just put a yes if you can see it? I just, um No. Okay. Okay. Um, I was open. You'll be able to see that. I will point out, um, those blank spaces, and then you can correctly label label them. Okay, um, just to give us a bit of an exercise to do, Um, yes. So, uh, so that that that wouldn't work. Then I thought, I'll be able to show you point out something, and then you can tell me what structure that is, what structure that is. But that's fine. So, um, the great vessels also enclosed in the pericardium in the ascending ascending aorta, the SV, see the pulmonary trunk. Um, we know that, um, we're still going to be talking about the art, but the pulmonary trunk from the ventricles, the S V c into the a trio. And basically that just what I wanted to show us here. And, um, could anyone just, um, just to engage us? What are the three branches of the attic act? If someone could just put that up just to make sure that we're following, um, purified. Enlarge the screen. That seems to be between larger screen. No, no, no. Uh, nothing left the screen. That's right. Okay. Um, nothing yet. Um, how weights your response is. Uh, I just want to engage us. Um, try to name okay. Yeah. So we can start from the top. Yes, that's fine. So from the top, the first box, that is. Thank you, Terry. Um, from the first box that is up there can so on name. What branch of the air to act that is. We could just put one. That's the second box would be to the third box. Will be 3/4 4 and the fifth five. Um, that's the one on the right hand inside. Let's ignore the two and then Okay. Okay. I can see some residences. The break is cephalic. Yes. So that's the right Brexit Phallic? Yes. Correct. Um, I think there should be a way that, uh, you can mute yourself. I'm not I'm not sure about if there's a way to speak. Okay. So, yes. So that's the first one up there is the right brachycephalic. Um Then we move on to the, um so Okay. Yes. So Okay. Yeah. So So now the room is not set up force, so I was forced to be able to speak, so Yeah. Okay, well, let's just move on from here. And then, um, because time is also fast spent. So, um, moving on to the pericardium. We've talked quite a bit of that. Um, is the fibers, um, enclosed, um, sac that encloses the art and the great vessels made up of, um, two layers, the fibers layer, um, which is the thick outer layer And, uh, Sarah Slayer. Um, the parietal, which is then divided into the perimeter and the visual layer. And in between this layer is the, um, pericardial cavity, which contains, um, pericardial fleet. Um, which is, uh, one common. Um um, on common. Um, problem is, when you have pericardial effusion, cardiac tamponade when the fluid, um, in the pericardial cavity becomes, um, too much and causes, Um um um, constriction prevents the art form. Um, um, from expanding. Basically, the function of the pericardium is to help to protect the act. Um, apart from protection, it also helps to retreat, um, to restrict excessive art movements. But when, um, the the pericardium, Sometimes the pericardium can become really thickened. And it prevents the arts from, um, prevent the art form. Um, contracting as it should adequately. And this can cause is when we say we have, um, constructive Perica diet ease. Um, where surgery has to be done in order to, um, strip up the pericardial layer in order to give the arts room for more um, for, um, for movements. Basically, um uh, pericardial pericardial effusion. Pericardial tampon. That is when the fluid in the pericardial cavity becomes too excessive. And, um, also causes some form of restriction to the movement of the arts. And, um, for pericardial tampon ad, this fluid is either too great or, uh accommodated truth quickly. And, um so from some of the form of, um, surgical emergency in which the fluids are the fluid around the heart has to be, um, immediately, quickly drained. Um, so that's the developments. So it's the fibers, the tick fibers. There is, um, the outer layer, while the the most serous serous layer is the inner layer of the of the pericardium. As you can see in the in the diagram and in pericarditis when there is inflammation of the pericardium, there is also, um um it's could cost fluid accumulation also lead to pericardial effusion. Um, that that we need to be dreamed. Okay, moving on. So we are now to the anatomy of the and now onto the anatomy of the heart, which is the the main bulk of, uh, today of today. So, um, talking about the development of the heart Canton. Um, just, um, put on the charts, if you have any idea what's Yeah, the So let's just say this is the layout. We're going to talk about the development you're talking about the location, the structure and also the, um we'll be talking about the conducting system of the art. So, um, so, to the development of the art, can anyone, um, tell us where the arts? Um, the art is formed from From from the Embryology. Now talking about embryology where the art develops from getting a response. Yet I just want to, um, engage just It just feels like I'm talking to myself for a while. There. Mhm. She doesn't. Okay. Yes. Correct. The methadone for the myocardium. Yes. Okay. I'm just waiting for um, people to respond, um, of some form of response from people. So the, um, had, um, forms from the, um it forms from the cephalic end of the ember, um, embryonic disc, basically. And where there is a splitting into the right and left Endo Cardia attitudes, which forms into a media, uh, endocardial tube. Um, later. And basically, um, So the attitude, which is, um um, of course, from a, uh, the cluster of cells in the missing time basically, is where the, um act develops from. And, as you can see in the diagram, can you hear me?