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Surgery > Cardiothoracic Surgery > Flashcards

Cardiothoracic Surgery Flashcards

1
Q

What are the indications for CABG? (5)

A
  1. more than 70% left main stem stenosis
  2. symptomatic patients with more than 70% proximal left anterior descending disease
  3. symptomatic patients with more than 70% disease in all three vessels
  4. concommittent valvular disease which requires replacement
  5. vessel disease in a diabetic
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2
Q

What can be used as a conduit in a CABG? (3)

A
  1. saphenous vein
  2. left internal mammary artery
  3. radial artery
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3
Q

What is the CABG procedure?

A

conduit is anastamosed to the coronary artery beyond the lesion and then to the ascending aorta

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4
Q

What conduit is the conduit of choice for a left anterior descending artery CABG?

A

left internal mammary artery/internal thoracic artery

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5
Q

What are the complications of CABG? (7)

A
  1. death - 0-1% in low risk patients
  2. stroke - 1-2% in low risk patients
  3. resternotomy for bleeding or tamponade - 5%
  4. chest infection
  5. atrial fibrilation
  6. wound infection
  7. renal failure
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6
Q

What are the characteristics of a mechanical valve?

A
  1. lifelong (more than 20 years)
  2. requires warfarin
  3. noisy - metallic click
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7
Q

What are the characteristics of a bioprosthetic valve?

A
  1. shorter life (10-15 years)
  2. no need for warfarin
  3. silent
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8
Q

What is involved in a standard tripple bypass?

A
  1. Left internal mammary artery to the left anterior descending artery
  2. portion of harvested great saphenous vein from aorta to the circumflex artery
  3. portion of harvested great saphenous vein to distal right coronary artery
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9
Q

What is the aetiology of aortic stenosis?

A
  1. calcific degeneration
  2. bicuspid valve
  3. rheumatic disease
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10
Q

What is the triad of symptoms seen in aortic stenosis?

A
  1. syncope
  2. angina
  3. dyspnoea
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11
Q

what are the signs seen in aortic stenosis?

A
  1. ejection systolic murmur, loudest in the aortic region and radiatin to the carotids
  2. heaving apex beat
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12
Q

What would an ECG show in aortic stenosis?

A

may show left ventricular hypertrophy

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13
Q

What investigations should be done for aortic stenosis?

A
  1. ECG
  2. TTE
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14
Q

What are the indications for surgery in aortic stenosis?

A
  1. mean gradient actoss valve greater than 40mmHg
  2. symptomatic aortic stenosis
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15
Q

What are the surgical options for aortic stenosis?

A
  1. open surgical aortic valve replacement SAVR via thoracotomy
  2. transcatheter aortic valve implantation TAVI
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16
Q

What is the most common valvular lesion?

A

aortic stenosis

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17
Q

What is the second most common valvular lesion?

A

mitral regurgitation

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18
Q

What is the aetiology of mitral regurgitation?

A
  1. mitral valve prolapse due to ischaemia
  2. rheumatic disease
  3. infective endocarditis
  4. connective tissue disorders
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19
Q

What is characteristic of mitral regurgitation?

A

holosystolic murmur loudest at apex +/- third heart sound that can radiate to the axilla

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20
Q

What is the clinical presentation of acute mitral regurgitation?

A

signs of CCF

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21
Q

What is the clinical presentation of chronic mitral regurgitation?

A
  1. exertional dyspnoea
  2. orthopnoea
  3. displaced apex beat
  4. atrial fibrilation in 80%
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22
Q

What investigations need to be done in mitral regurgitation?

A
  1. TTE
  2. TOE
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23
Q

What are the indications for surgery in mitral regurgitation?

A
  1. acute mitral regurgitation
  2. severe chronic mitral regurgitation
24
Q

What ate the surgical options for mitral regurgitation?

A
  1. open valve replacement
  2. endovascular mitraclip
25
Q

What is the prevalence of mitral stenosis?

A

less than 1%

26
Q

What is the clinical presentation of mitral stenosis?

A
  1. rumbling mid diastolic murmur at apex
  2. signs of right heart failure - due to increased pulmonary vascular resistance
  3. atrial fibrilation
    4, left parasternal heave
  4. tapping apex beat
27
Q

What investigations should be done in mitral stenosis?

A
  1. CXR showing splaying of carina
  2. TTE/TOE
28
Q

What are the surgical options for mitral stenosis?

A
  1. percutaneous valvotomy
  2. open mitral valve replacement
29
Q

What is the prevalence of aortic regurgitation?

A

less than 1%

30
Q

What is the aetiology of aortic regurgitation?

A
  1. rheumatic disease
  2. marfan’s syndrome
  3. large vessel vasculitis
  4. infective endocarditis
  5. aortic dissection
31
Q

What is the clincal presentation of aortic regurgitation?

A

early diastolic murmur

32
Q

What is the presentation of acute aortic regurgitation?

A

signs of left ventricular failure

33
Q

What are the common causes of acute aortic regurgitation?

A

endocarditis
aortic dissection

34
Q

What is the presentation of chronic aortic regurgitation?

A

often asymptomatic

35
Q

What does aortic regurgitation show on a CXR?

A

cardiomegaly

36
Q

What investigations should be done for aortic regurgitation?

A

CXR
TTE

37
Q

What are the indications for surgery in aortic regurgitation?

A
  1. acute AR
  2. chronic AR
  3. left ventricular dilation more than 5.5 cm
38
Q

What is the definition of a pneumothorax?

A

presence of air in the pleural space with varying degrees of secondary lung collapse

39
Q

who does primary spontaneous pneumothorax occur in most commonly?

A

tall young men

40
Q

What side is a primary spontaneous pneumothorax most common in?

A

right sided

41
Q

What is a primary spontaneous pneumothorax caused by?

A

caused by rupture of small pleural blebs

42
Q

Where is a primary spontaneous pneumothorax usually found?

A

usually found in the apex

43
Q

what are the clinical features of primary spontaneous pneumothorax?

A
  1. dyspnoea
  2. chest pain
  3. tachypnoea
  4. hyperresonant hemithorax
  5. absent breath sounds
44
Q

what investigations should be done in the case of a primary spontaneous pneumothorax?

A

CXR
CT thorax

45
Q

What are the complications of a primary spontaneous pneumothorax?

A

tension pneumothorax
pneumomediastinum
haemopneumothorax
recurrent pneumothorax

46
Q

How is a spontaneous primary pneumothorax managed conservatively?

A

if small and asymptomatic repeart CXR and supplemental oxygen

47
Q

How is a spontaneous primary pneumothorax managed conservatively?

A

if small and asymptomatic repeart CXR and supplemental oxygen

48
Q

When is needle aspiration done in a primary spontaneous pneumothorax?

A

if more than 2cm rim of air seen

49
Q

When and where is a chest tube inserted in the case of a spontaneous primary pneumothorax?

A

when aspiration fails
where: fourth to fifth intercostal space in the mid axillary line

50
Q

What is the aetiology of secondary spontaneous pneumothorax?

A

chronic airway or alveolar disease
systemic connective tissue disorders
malignant lung and chest disease

51
Q

What chronic airway or alveolar diseases can cause a secondary spontaneous pneuomothorax?

A

severe asthma, cystif fibrosis, emphysema

52
Q

What systemic connective tissue disorders can cause secondary spontaneous pneumothorax?

A

rheumatoid arthritis, ankylosing spondylitis, scleroderma, marfans syndrome, ehlers danlos syndrome

53
Q

What malignant disease can cause secondary spontaneous pneumothorax?

A

bronchial cancer, sarcoma

54
Q

What are the borders of the triangle of safety?

A

lateral border of pectoralis major, anterior border of latissmus dosi

55
Q

How is a chest tube inseted?

A

inserted in the fifth intercostal space anterior to the mid axillary line, just above the rib to avoid the neurovascular bundle

56
Q

How to confirm chest tube has been placed correctly?

A
  1. bubbling of air in the underwater chamber
  2. oscillation of fluid in the tube with the patients breathing
  3. post insertion CXR

Surgery (3 decks)

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