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Flashcards in home made practice exam Deck (21):
1

Define zone for stenting

0 ascending and brachiocephalic a.
1 common carotid a. Region
2 left subclavian region
3 isthmus region
4 descending

2

Cut off when aorta rupture or dissect

Ascending 6 cm ( lifetime risk jump to 30%)
Descending 7 cm (lifetime risk jump to 40%)


Yearly risk of composite of death,rupture or dissection

Overall if more than 6 cm 14%
If between 5 and cm 6,5%

3

Growth rate of aneurysm

Ascending 0,1 cm per year
Descending 0,3 cm per year

4

Time for safe DHCA depending on Temp

15 degree 25 min
20 degree 20 min
25 degree 15 min

5

Way to monitor brain in arch surgery

NIRS
Jugular sat
Transcranial Doppler
EEG
Evoked potential

6

Ante grade perfusion: rate and pressure

10 cc/kg/min
Pressure between 50-60
As low as 40 acceptable
More 70-80 if carotid lesion

7

Axillary cannulation
Advantages and disadvantages

Advantages
Antegrade flow
Less malperfusion risk
Less arch manipulation (stroke)
Easy to convert to cerebral perfusion


Disadvantages
Vessel trauma
Plexus trauma

8

What about Femoral cannulation

Advantages
Fast
Easy

Disadvantages
Malperfusion
Retrograde perfusion (stroke)

9

Alpha vs ph stat

Alpha
Maintain cerebral autoregulation
Better enzymatic function

Ph
Cerebral vasodilatation ( easier cooling but more stroke risk)
Left shift of oxyHb curve ( better oxygen availability)

10

What about retrograde perfusion

Good for cooling and flushing debris
Better than DHCA alone
Not so good for nutritional support

Risk of cerebral edema

Maximal pressure 25 mmHg and flow between 300-500cc per min

11

Surgical adhesives pro and con

Pro
Hemostatic
Reinforce tissue
Anastomotic support
Reduce transfusion

Con
Toxicity (aldehyde part)
Need a dry field
Preparation time
Infection risk
Stricture ( so avoid in peds)
Embolisation

12

3 characteristics of CRT patient

FC > II
EF < 35
Conduction delay 150ms

13

Succes rate of CRT

66%

14

Class 1 indication PPM

Sinus node dysfunction
Symptomatic Brady
Chronotropic incompetence
Symptomatic Brady because of required med

AV dysfunction
3 and advanced AV block with
Symptoms
Required med therapy causing bradycardia
Pause 3 sec
Rate less than 40
After KT ablation
After cardiac surg
LV dysfct

After MI
Alterning LBBB and RBBB with 2 degree
Symptomatic 2 or 3 degree

15

Indication class 1 defibrillator

Cardiac arrest with VF or VT after excluding reversible cause
Structural heart disease with VT
Syncope unknown origins, VT induced in lab
40 days after MI and EF < 35 and symptoms
40 days after MI and EF < 30 no symptoms
40 days after MI and EF < 40 with inducible VT
Non ischemic CMP with EF < 40 and symptoms

But if surgically revascularized may wait 3 months before taking the decision

16

Most common complication of device (PPM, defibrillator

Lead displacement 2%

17

Cryo pro and con

Pro
Spare collagen structure

Con
Longer
Bad on beating heart


Other sources are radiofrequency, HIFU, microwave and laser

18

Indications to do a MAZE

Symptomatic AF undergoing an other cardiac procedure
Asymptomatic AF undergoing an other cardiac surgery with no extra risk to do it
Stand alone AF if meds or KT failed when symptomatic

Controversial : contraindications to ACO

19

Prevention of AF CCS guidelines

Start beta blocker preoperatively
Preoperatively or postoperative amio
Magnesium
Atrial pacing

20

Cardiac neoplasia
Name 4 more frequent
Primary benign adult
Primary benign peds
Primary malignant
Secondary

Benign adult
Myxoma
Lipoma
Fibroelastoma
Hemangioma

Benign peds
Rhabdomyoma
Teratoma
Fibroma
Hemangioma

Primary malignant
Angiosarcoma
Rhabdomyosarcoma
Mesothelioma
Fibrosarcoma

Secondary
Leukaemia
Melanoma
Lung
Breast

21

Aortic dissection classification

Stanford
A involving ascending
B not involving ascending

DeBakey
I ascending and descending
II ascending
IIIa descending until diaphragm
IIIb descending and below diaphragm

Independent from the tear*****

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