Previous exam 2007 Flashcards
6 anatomical layers cross with axillary artery cannulation
Skin subcutaneous tissue/fat pec major Clavico-pectoral fascia pec minor axillary sheath wall of artery (adventitia)
2 ways to cannulate are 1) Direct 2) through an end to side Dacron graft (8 or 10 mm)
The day after on pump CABG, with TEE monitoring, patient develops resp failure, leukocytosis, fever and pleural effusion. pH of pleural fluid is 7.2
What is diagnosis
Initial management
Surgical managment
Esophageal perforation
Chest tube, NPO, NG, Barium swallow, Broad spectrum Abx, CT thorax
Thoracic surgery consult, debridement of esophageal tear, primary closure of mucosa, sub mucosa, adventitia
4 possible advantages of axial flow pumps and 1 disadvantage
Minimal aticoagulation Quiet Small size Less power consumption durability
Disadvantage
Hemolysis/shear forces
non-pulsatile
Potential for negative ventricular pressure (air embolism, device thrombosis)
What is difference between dilated cardiomyopathy and hypertrophic cardiomyopathy
LVEF (reduced, normal)
LVEDV (increased, reduced)
LVESV (increased, reduced)
LV mass (increased, increased)
LV mass/volume (decreased, increased)
LV chamber thickness (deceased, increased)
Wall tension (increased, normal/increased)
What is Vo2 max effect on survival
if < 10 (50% die in one year)
if 10 to 18 (65-80% survival in one year)
if > 18 then (>95% survival in one year)
List factors that make SAM worse
Inotropes
Decrease in afterload
decrease in preload
tachycardia
What are risk factors for SAM
increase height of posterior leaflet of mitral valve
small left ventricle
narrow angle between mitro-aortic angle
Hypertrophic septum
What is JVP tracing in patient with AF…Draw it
No a wave, small x descent, large v wave, prominent y descent
What is the relevance of Intravascular ultrasound
Mean lumen diameter of 4.0 mm2 has been assessed as being a the cutoff threshold for intervention.
What are 5 complications from Fontan physiology
Protein losing enteropathy Arrhythmias cyanosis Conduit obstruction failing fontan circulation (higher PVR, single ventricle failing) exercise intolerance Thromboembolic Hepatic dysfunction
Strategies to reduce the risk of neuro dysfunction on pump CABG
hypothermia slow rewarming epiaortic scanning minimal manipulation of aorta higher perfusion pressures lower CPB times anti-inflammatory strategies Avoid cardiotomy suction
Describe approach to a root abscess under left main
Adequate debridement, closure of abscess cavity, assessment of anterior leaflet of mitral valve, assessment of left main coronary artery involvement. Reconstruction of the root with dacron or pericardial patch, new valve implantation, protect LM from emboli, retrograde cardioplegia
Name 3 possible substitues for aortic valve in the case of annular abscess
Homograft
Stented bioprosthesis
stentless aortic valve
mechanical aortic valve
What are 6 causes of tricuspid valve regurgitation in a 71 year old female with normal coronary arteries
Primary
myxomatous/degenerative changes, rheumatic, carcinoid, infectious
Seconday
Myxoma, high pulmonary vascular resistance, mitral regurgitation, right ventricle/annulus dilation
Name 2 most common malignant carid tumors and survival time. Name 1 clinical and 1 anatomical feature prior to planning a surgery
Angiosarcoma–50% death at 6 months
Rhadomyosarcoma–50% at 6 months
Angiosarcoma – if not resected 90% die within 1 yr.
Rhabdomyosarcoma – < 12months even with resection
???feature: local disease that is resectable with no evidence of metastasis
