overview of cardiac sx

Question 1

What are the 4 different strategies for cardiac surgery

Answer 1

1) Beating Heart Surgery
2) Inflow occlusion/brief circulatory arrest
3) Cardiopulmonary bypass
4) Hybrid cardiac surgery

Question 2

What is the intent of PDA ligation surgery

Answer 2

Curative

Question 3

What is the intent of pulmonary banding for VSD

Answer 3

Palliative

Question 4

What is the intent of modified Blalock-Taussig Shunt

Answer 4

Palliative for Tetralogy of Fallot

Question 5

modified Blalock-Taussig Shunt is for

Answer 5

Palliative for Tetralogy of Fallot

Question 6

What is the intent of Epicardial Pacemaker

Answer 6

Curative for AV block and SA node dysfunction

Question 7

Types of beating heart surgeries

Answer 7

1) PDA ligation (curative)
2) Pulmonary banding (palliative for VSD)
3) Modified Blalock Taussig Shunt (Palliative for Tetralogy of Fallot)
4) Epicardial Pacemaker (Curative for AV block and SA node dysfunction)

Question 8

T/F: PDA ligation is curative

Answer 8

True

Question 9

What is a downside to PDA ligation

Answer 9

1) Expensive
2) Not everyone can undergo minimally invasive catheter procedure due to size and availability

Question 10

What heart condition if the dilatable pulmonary artery banding for

Answer 10

VSD

Question 11

What occurs with a VSD

Answer 11

Increase blood floe to the lungs, LA and LV

causes LA/LV dilation and a volume overload

the increased pulmonary vascular resistance and pressure overload leads to RV hypertrophy

once R pressure gets high enough it shunts R to L and cyanosis occurs (Eisenmenger’s Syndrome)

Question 12

Eisenmenger’s Syndrome

Answer 12

When a L to R shunt reverses and becomes R to L due to increased RV pressure overload from increased pulmonary artery overload

Question 13

How does dilatable pulmonary artery banding work to correct VSDs

Answer 13

Band across the pulmonary artery so that the pressure of the right side increases to be equal to the left side so there isnt as much movement between them

this is palliative

Question 14

dilatable pulmonary artery banding is indicated as palliative therapy got

Answer 14

VSD L to R shunt

Question 15

What are the 4 features of Tetralogy of Fallot

Answer 15

1) Pulmonic stenosis
2) VSD
3) Overriding aorta
4) RV hypertrophy

Non-oxygenated blood goes through shunt and out to circulation

a cyanotic congenital heart disease

Question 16

modified Blalock-Taussig Shunt attaches the _____ to the _____

Answer 16

Left Subclavian artery to Pulmonary artery

Question 17

Why might you give a patient an epicardial pacemaker

Answer 17

For cases of AV node block or Sick Sinus Syndrome - altenrative to endocardial pacemaker

1) Complications related to endocardial pacemaker - infection, hypercoagulability, immunosuppressed
2) Cats or small breed dogs
3) Other cardiothoracic or abdominal surgery

Question 18

What is an approach to modified Blalock-Taussig Shunt

Answer 18

1) Transdiaphragmatic approach - hard for deep chested dog

2) Medial thoracotomy

Question 19

procedures that provide brief period of circulatory arrest <2 minutes allowing for simple intracardiac procedures

Answer 19

Venous inflow occlusion

Question 20

Venous inflow occlusion is where you provide brief period of circulatory arrest <2 minutes allowing for simple intracardiac procedures.

What are these procedures

Answer 20

1) Intracardiac masses
2) Cor triatriatum
3) Cardiac foreign body

Question 21

rare congenital heart defect that divides the left or right atrium of the heart into three chambers.

Answer 21

Cor triatriatum

-approach surgery by doing venous inflow occlusion

Question 22

What are the advantages of venous inflow occlusion

Answer 22

1) Simple
2) Specialized equipment not required
3) Minimal systems derangement

Question 23

What are the disadvantages of venous inflow occlusion

Answer 23

1) Very limited time available
2) Cardiac motion
3) Limited rescue options

Question 24

Venous inflow occlusion indication

Answer 24

Curative or Palliative

Question 25

Strategy for open cardiac surgery that utilizes an extracorporeal circuit to oxygenate blood and provide systemic perfusion

Answer 25

Cardiopulmonary bypass

Question 26

What procedures can be done with cardiopulmonary bypass

Answer 26

1) Septal defect repair (partial or complete AVSD) 2) AV valve disease- dysplasia of mitral or tricuspid (annuloplasty band) 3) Tetralogy of Fallot

Question 27

In cardiopulmonary bypass venous cannula attached to: arterial cannula attached to:

Answer 27

Venous: Jugular or r auricle Arterial: femoral or carotid artery

Question 28

What skills are needed for cardiopulmonary bypass

Answer 28

1) Cardiopulmonary physiology 2) Medical cardiology 3) Knowledge of perfusion 4) Systemic effects of CPB 5) Post-operative management 6) Team effort Team 1) Surgical 2) Medical 3) Anesthesia 4) Perfusionist 5) CCU 6) Blood bank

Question 29

With cardiopulmonary bypass, how can you do valve repair for mitral or tricuspid valve dysplasia

Answer 29

1) Artificial chordae placement 2) Annuloplasty band

Question 30

With cardiopulmonary bypass, how is a partial atrioventricula septal defect repaired

Answer 30

Valve repair and ASD patch

Question 31

What are different items to replace the atrioventricular valve with in cases of mitral valve dysplasia, MMVD, tricupsid valve

Answer 31

1) Bioproesthetic valve 2) Mechanical valve 3) Allograft (not available in vet patients)

Question 32

Atrioventricular valve replacement can be done for

Answer 32

1) Mitral valve dysplasia 2) MMVD 3) Tricuspid valve disease

Question 33

surgery that is performed on the beating heart using minimally invasive approaches and catheter based delivery systems under advanced imaging systems

Answer 33

Hydbrid cardiac surgery

Question 34

What are types of hybrid cardiac surgery

Answer 34

1) Transcatheter Edge to Edge Mitral Valve Repair 2) Transcatheter Valve Implacement (replacement) 3) Hybrid Aortic to Pulmonary Shunt

Question 35

What is V-clamp

Answer 35

A hybdrid cardiac surgery method where there is a transcatheter edge to edge mitral valve repair grabbed edge of mitral leaflet and close them together, this reduces the amount of mitral regurgitation has a canine device

Question 36

10 yo MC schnauzer presented with collapsing episodes at home. He presented to a local ER and EKG was obtained, which was consistent with sick sinus syndrome (SSS). He has been diagnosed with Cushings and CKD. WHat is best option for this dog for SSS?

Answer 36

Epicardial pacemaker placement

Question 37

3 month old FI DSH presented for an initial check up at vet. No abnormal clinical signs. During PE, grade IV/VI continuous heart murmur at left heart base. After seeing a local cardiologist, this cat was diagnosed with PDA. What would be the most reasonable option for Tx?

Answer 37

Surgical ligation without CPB