101-200 Flashcards Preview

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Flashcards in 101-200 Deck (97)
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1

Repair of descending aneurysm: 

after proximal anastomosis, how should flow to the head and heart be re-instituted  

Arterial flow is re-instituted either through the axillary or a perfusion cannula into the graft. 

Flow should be restarted slowly at 500-700cc.hr 

2

Descending aortic dissection 

% of patients with visceral malperfusion ? 

what is the most common mechanism of malperfusion ? 

21% of patients have visceral malperfusion 

80% of these cases are dynamic branch compromise 

3

Dynamic branch compromise 

Most common type of malperfusion following repair of Type B dissection (80% of cases) 

Due to narrowing or compression with the majority of flow through the false lumen compressing the osteal opening 

4

Static branch malperfusion 

Dissection flap or intimal tear extends into the branch leading to obstruction of flow from intimal intussusception 

Maybe augmented by the presence of a thrombus 

This may be treated percutaneously 

5

WHO Pulmonary Hypertension Classification 

○ WHO Group I -

○ WHO Group I - Pulmonary arterial hypertension (PAH)

 

6

WHO Classification of pulmonary hypertension 

○ WHO Group II -

 

○ WHO Group II - Pulmonary hypertension associated with left heart disease

7

WHO Pulmonary HTN Classification 

○ WHO Group III -

○ WHO Group III - Pulmonary hypertension associated with lung diseases and/ or hypoxemia

8

WHO Classification of Pulmonary hypertension 

○ WHO Group IV -

○ WHO Group IV - Pulmonary hypertension due to chronic thrombotic and/ or embolic disease

 

9

WHO Classification of pulmonary hypertension 

○ WHO Group V 

○ WHO Group V - Miscellaneous.

10

WHO Classification 

 Pulmonary arterial hypertension (PAH)

 

○ WHO Group I - Pulmonary arterial hypertension (PAH)

11

WHO Classification 

Pulmonary hypertension associated with left heart disease

 

○ WHO Group II - Pulmonary hypertension associated with left heart disease

12

WHO Classification: 

 Pulmonary hypertension associated with lung diseases and/ or hypoxemia

 

○ WHO Group III - Pulmonary hypertension associated with lung diseases and/ or hypoxemia

 

13

WHO Classification 

 Pulmonary hypertension due to chronic thrombotic and/ or embolic disease

 

 

○ WHO Group IV - Pulmonary hypertension due to chronic thrombotic and/ or embolic disease

 

14

What is a non-restrictive VSD ? 

Left and right ventricular pressures equalize 

15

What are the major factors that impact the flow patterns across a VSD ? 

  1. Chief factor: Pulmonary / Systemic resistance 
  2. Size of the Defect 
  3. Others 
    • HCT (viscosity) 
    • CO (velocity) 

16

What determines the Qp/Qs in a non-restrictive VSD 

Difference in the pulmonary - systemic vascular resistance 

17

What determines the Qp/Qs in a restrictive VSD 

(PVR + Gradient across the VSD) - SVR 

18

How does VSD size impact the flow across it ?

As the size of the VSD --> 50% of the aortic annulus the flow becomes non-restrictive 

19

General categories of VSD 

  1. Inlet 
  2. outlet 
  3. Perimembranous 
  4. Muscular t

20

A child with swiss cheese VSD 

flow left to right 

Qp/Qs  > 2.1 

approach ?

 

1. Pulmonary banding 

2. most of the defects will close with time 

21

Describe the conduction system with respect to a conal VSD 

Conduction system is remote 

22

Conduction system with respect to a d-looped perimembranous VSD 

 

posterior and inferior to the defect 

- place sutures on the RV side only 

23

Conduction system with respect to a perimembranous defect with l-looped ventricles 

anterior and superior to the defect 

24

Conduction system with respect to an inlet VSD 

apex of the triangle of koch 

25

Infective endocarditis 

- overall 6-month mortality 

20-25% 

26

Infective endocarditis 

- perioperative mortality 

10% 

27

Infective endocarditis 

The rate of re-infection of a prosthesis?

2% 

28

Native valve endocarditis 

Class I Indications for Surgery 

(ACC/AHA 2006/2014/2017; ESC 2009, 2015)

Class I

  1. Heart Failure
  2. Evidence of LV dysfunction or PA HTN
  3. Abscess, Fistula, Pseudo-Aneurysm
  4. Fungal or highly resistant bacterial IE
  5. Persistent bacteremia after 1 week Ab Rx

Mnemonic: 

F HEAP (Fungus, heart failure, EF(low), Abscess), Persistent Bacteremia) 

29

Native Valve Endocarditis 

Class II Reccomendations 

(ACC/AHA 2006/2014/2017; ESC 2009, 2015)

 

Class II Reccomendations 

Recurrent emboli and persistent vegetation despite appropriate AB Rx (IIa)

Large ( > 10mm) mobile vegetation, particularly on AMVL (IIb)

Increase in vegetation size on AB Rx (IIb)

30

Prosthetic valve endocarditis 

Class I Indications for surgery 

  1. Heart Failure (IB)
  2. Severe prosthetic valve dysfunction (IB)
  3. Dehiscence, abscess, fistula, etc. (IB)
  4. Fungal or highly resistant bacterial PVE (IC)