Cardiac Surgery

Question 1

Describe the anatomy of the cardiac chambers

Answer 1

RA - Tricuspid - RV - Pulmonary - Pulmonary Artery - LA - Mitral - LV - Aortic - Aorta

Question 2

Describe the cardiac conduction system

Answer 2

AV node - SA node - Bundle of his - Purkinje fibres

Question 3

Describe the coronary arteries

Answer 3

Originate from the aortic valve
RCA - RMA & PDA
LCA - Circumflex & LAD

Question 4

What is open heart surgery?

Answer 4

Any surgery requiring cardio-pulmonary bypass

Question 5

What is cardiopulmonary bypass?

Answer 5

Cardiopulmonary bypass takes over the function of the heart and lungs allowing for a motionless, blood free field for operation

Question 6

How is cardiopulmonary bypass initiated?

Answer 6

Ascending aorta clamped and cannulated

Venous line inserted into RA to drain venous blood

Question 7

How is the risk of ischaemic damage minimised on bypass?

Answer 7

Heart arrested in high potassium solution and by cooling the myocardium (4-12)

Question 8

What is the main complications of bypass?

Answer 8

Activation of the clotting cascade

Question 9

What are the major branches of the aortic arch?

Answer 9

Brachiocephalic (R CC, R SCA)
L CC
L SCA

Question 10

What are the main incisions in cardiac surgery?

Answer 10

Median sternotomy
Anterolateral thoracotomy
Posterolateral thoractoomy
Bilateral transverse thoracotomy (clam shell)

Question 11

Describe a median sternotomy incision

Answer 11

Midline incision, most common approach, any chamber/surface operable

Question 12

Describe an anterolateral thoracotomy incision

Answer 12

Access to right side of heart

Question 13

Describe a posterolateral thoracotomy incision

Answer 13

Access to distal aortic arch & descending thoracic aorta

Question 14

Describe a bilateral transverse thoracotomy incision

Answer 14

Popular for double lung & heart-lung transplants

Question 15

Describe CABG as used for coronary artery disease

Answer 15

Performed through median sternotomy incision

Commonly uses L internal mammary artery

Question 16

What are the complications of CABG?

Answer 16

MI
Haemmorhage
Stroke
Arrhythmias
Tamponade
Aortic dissection

Question 17

How can prosthetic valves be classified?

Answer 17

Man-made

Tissue

Question 18

Describe man-made valves

Answer 18

Durable
Thrombogenic (require warfarin)
Produce valvular click

Question 19

Describe tissue valves

Answer 19

Homographs/xenografts
Anticoagulation not required
More prone to degenerative failure

Question 20

What are the two main types of cardiac trauma?

Answer 20

Blunt (non-penetrating)

Penetrating

Question 21

Describe the management of blunt cardiac trauma

Answer 21

CXR in resus
CT often required
Can give ECG changes similar to MI
Conservative management

Question 22

Describe the management of penetrating cardiac trauma

Answer 22

Complex surgical management required

Rounded heart border on CXR

Question 23

What is Beck’s triad?

Answer 23

Sx suggestive of cardiac tamponade

• Hypotension
• Raised JVP
• Muffled heart sounds

Question 24

What is a myxoma?

Answer 24

Benign myocardial tumour

Question 25

How do myxomas present?

Answer 25

Similar to infective endocarditis/mitral stenosis

Question 26

How are myxomas managed?

Answer 26

Confirmed by echo and treated w/ excision

Question 27

What is constrictive pericarditis?

Answer 27

Pericardial inflammation resulting in constriction of the whole pericardium

Question 28

In what conditions does constrictive pericarditis occur?

Answer 28

TB
RA
Pericardial trauma/radiotherapy

Question 29

How does constrictive pericarditis present?

Answer 29

Pulmonary/systemic congestion

Question 30

How is constrictive pericarditis managed?

Answer 30

Excision of whole pericardium