02.18b Surgical Management for Valvular Heart Disease Flashcards Preview

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Flashcards in 02.18b Surgical Management for Valvular Heart Disease Deck (59):
1

Etiology of MS

Rheumatic fever
RHD

2

Pathophysiology of MS

Leaflet thickening or calcification
Commissural fusion
Chordal fusion and shortening

3

Exertional dyspnea
Decreased exercise capacity
Orthopnea/paroxysmal nocturnal dyspnea
Hemophysis and pulmonary edema
Pulmonary hypertension
Afib

MS

4

Auscultatory findings in MS

Increased first heart
Opening snap
Apical diastolic rumble

5

Primary cause of mortality for MS

Progressive pulmonary and systemic congestion

6

CXR findings for MS

Straight left border (left atrial enlargement, pulmonary artery enlargement)
Double contouring

7

For ruling out left atrial appendage thrombus and Mr severity for percutaneous mitral balloon valvotomy candidates

Transesophageal echocardiography

8

First choice of treatment for MS

Percutaneous mitral balloon valvotomy

9

lf not amenable for valvotomy

Commissurotomy
Mitral valve repair or replacement

10

Etiology of MR

Mitral valve prolapse
RHD
CAD
Infective endocarditis
Certain drugs
Collagen diseases, carcinoid diseases
Trauma
Previous chest radiation

11

Apical holosystolic murmur and forceful apical impulse
Transmitted to the left axilla or left sternal border

MR

12

Insufficiency occurs secondary to annular dilatation or leaflet perforation with normal leaflet motion

Type I

13

Thickened leaflet prolapsed, or ruptured or elongated chordae tendinae with increased leaflet motion
Myxomatous conditions, MVP

Type II

14

Restricted leaflet motion
RHD, chronic ischemic MR

Type III

15

If you have MR, what to find in ECG

LA and LV enlargement

16

Evaluate LV size and function, RV and LA size, PA, MR severity
To evaluate MR mechanism

Transthoracic echocardiograph

17

Establish anatomic basis of MR to assess feasibility of repair, and guide the repair

TEE

18

Indications of surgical intervention for patients with MR

Any symptomatic patient with MR
Asymptomatic severe MR with LV systolic dysfunctions
*Recent onset of Afib, pulmonary HPN, abnormal response to stress testing

19

Treatment of choice for MR

Mitral valve repair

20

Etiologies of AS

Calcification
Congenital
Rheumatic

21

Pathophysiology of AS

Pressure overload

22

Exertional dyspnea
Angina
Syncope
Decreased exercise capacity
Heart failure

AS

23

Harsh, crescendo-decrescendo
Systolic murmur at right 2nd ICS
Radiating to carotid arteries

AS

24

ECG findings in AS

LV hypertrophy
Conduction abnormalities, Afib

25

Exercise testing of AS

Dobutamine stress echocardiography

26

Procedure for AS with CAD risks, symptomatic but inconclusive results in non invasive tests regarding AS severity

Cardiac catheterization

27

Management of AS

Medical therapy
Aortic balloon valvotomy
Surgery

28

Etiology of AR

Aortic root disease
Congenital
Calcific degeneration
Rheumatic disease
Infective endocarditis
Myxomatous degeneration

29

What will happen if the heart keeps pumping blood to the aorta and blood keeps coming back

Left ventricular dilatation

30

AS is ______
AR is ______

Pressure overload
Volume overload

31

High pitched decrescendo diastolic murmur in 3rd ICS

AR

32

Bounding pulses quickly collapsing pulses

Corrigan's sign

33

Pistol shot sounds by auscultation

Traube sign

34

ECS findings in AR

Left axis deviation
Intraventricular conduction defects

35

Assess the severity, cause of AR, degree of pulmonary HPN

TTE

36

Considered surgical emergency in AR

With aortic dissections
Infectious endocarditis with severe AR in failure

37

Has traditionally been performed through a median sternotomy incision

Aortic valve replacement

38

Types of surgery

Aortic valve replacement
Aortic valve repair

39

Etiology of TS

Organic (rheumatic fever, endocarditis, rarely trauma)

40

Etiology of TR

Functional (mitral valve disease, pulmonary hpn, RV failure)

41

Pathophysiology of TR/TS

Elevated RA pressure
Right heart failure

42

Signs of severe TS

Jugular vein distension
Hepatomegaly
Splenomegaly
Ascites
Lower extremity edema

43

Diagnosis of TS

CXR
TTE (size, structure, motion)

44

Management of TS

Tricuspid valve repair
Tricuspid valve replacement

45

Pathology of multivalve disease

Rheumatic heart disease
Calcific disease
Marfan syndrome
Secondary to another valve pathology

46

Advantages of mechanical aortic prosthesis

Highly durable
Minimized risk for reoperation

47

Disadvantages of mechanical aortic prosthesis

Require permanent anticoagulation (warfarin)
Risk of hemorrhagic complications
Lifestyle changes

48

Types of valve of mechanical aortic prosthesis

Ball-cage valve (Starr-Edwards)
Single titling disc (Medtronic-Hall, Ominicarbon)
Bileaflet prosthesis

49

Advantagaes of biologic valves

Less thrombogenic
Less anticoagulant-related complications
Good for older population

50

Disadvantages of biologic valves

More prone to structural failure
Higher chance of reoperation

51

Types of biologic valves

Stented and non-stended heterografts
Homografts
Autografts (pulmonic valve auto-transplantation, Ross operation)

52

Recommendation for warfarin INR 2-3

Increase INR to 2.5-3.5

53

Recommendation for warfarin INR 2.5-3.5

Increase INR to 3.5-4.5

54

Recommendation for no aspirin

Starts ASA 75-100mg

55

Recommendation for warfarin plus ASA

May increase ASA to 325mg

56

Recommendation for ASA alone

Increae ASA to 325mg or add Clopidogrel 75 mg OD and/or warfarin

57

What level of INR is at higher risk for hemorrhage

> 5

58

What to do when INR is 5-10 and not bleeding

Withhold warfarin, serial INR
Vit K1 (phytonadione)
Restart warfarin

59

What to do in emergency cases of bleeding

Transfuse fresh frozen plasma
Low dose Vit K