Previous exam 2004 Flashcards Preview

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Flashcards in Previous exam 2004 Deck (48):
1

What is management post PA rupture

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2

What are indications for Pulmonary valve replacement in a 15 year old with a TOF repair

PVR with RV failure or overload
symptomatic
arrythmias
severe TR

3

What is mechanism of amiodarone induced lung toxicity

Direct injury to lung
accumulation of cellular drug phospholipid complexes that interfere with normal cell pathways
toxic oxygen
chronic inflammtion
Indirect immunologic reaction

Treatment is just cessation of amiodarone and corticosteroids

4

How do you reverse dipyridamole toxicity

Persantine (antiplatelet agent) inhibits adenosine deaminase and phosphdiesterase which cases an ccumulation of adnonsine, cAMP. These inhibit platelet aggregation and may cause vasodilation

platelet transfusion to reverse effect

5

Mechaniam of protamine-induced pulmonary hypertension. What do you do if need to re-op

Protamine is administered at 1-2 mg/100units of heparin
heparin protaimine complex causes the release of thromboxane
Alternatives to protamine
Give a protamine test dose of 1 mg over 10 minutes
heparinases
recombinatn PF4
Hedadimethreine bromide
time
methylene blue

6

Torrential venous bleeding on dissecting out the SVC for bicaval cannulation. Name 3 potential sources

SVC
Right pulmonary artery
Right atrium
Left atrial roof
Azygous vein

7

Draw pressure volume loops...How do inotropes shift the curve.

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8

List 4 qualities on echo that would help determine if Balloon plasty for mitral stenosis is ok

Mitral regurgitation > 2+
Massive or bicommissural calcification
left atrial thrombosis
Severe aortic valve disease or severe tricusoid stenosis + regurgtiation
severe CAD

9

VAD inserted for support..CVP gets elevated, decreased cardiac output, and urine output decreases

Likely cause is bleeding

Second option is right heart failure

Could be patent foramen ovale with left to right shunting and now you have RV overload and failure.

Echo, return to OR,

10

Indications to do CABG in shock situation

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11

Indications for surgery of Left ventricular aneurysm

angina
congestive heart failure
selected ventricular arrhythmias
increasing size
embolism

12

List 8 symptoms of Left atrial myxoma

Heart Failure
Embolization
Fever
Weight loss
Elevated ESR
Hemoystic anemia
Leukocytosis
Arthralgia
Tumor plop
Right sided heart failure--ascites, edema, heptomegaly

13

List 2 inclusion criteria for patients to receive cardiac resynchronization

advanced heart failure
intra-ventricular conduction delay

14

How does resynchronizatino improve symptoms

Improves ventricular contraction (Left ventricue)
improves the coordination of global contraction
Associated with reverse remodelling
Decreased MR jet areas
Reduction in LV mass
Improvement in hemodynamics

15

List 4 factors in determining decision to use a radial artery

Lack of conduits
younger patient age
extent of proximal stenosis
target vessel run off
-ive Allen test/vascular assessment

16

Two reasons why initial use of radial is associated with poor results

Vasospam
Use of vessels with low grade proximal stenosis

17

What is Laplace formula

Tension = Pressure x radius/ 2

18

4 reasons why you would develop mesenteric ischemia post AVR with calcium

Emboli
Aortic dissection
hypoperfusion 2nd to low blood pressure
Mesenteric vasoconstriction secondary to epinephrine

19

4 risk factors for post op AF after CABG

Advanced age
beta blocker withdrawal
preexisting AF
Extended cross clamp time

Incidence of AF post CABG is 25%

20

What are absolute contraindications to Ross Procedure

Advanced 3 vessel CAD
Extremes of Age (< 1 year or > 70)
Marfan syndrome
Multi system organ failure
Extensive multi valve pathology necessitating replacement of one or more valves
Large aortic root diameter (> 30mm)
Severely decreased left ventricular function

21

What are medical and surgical outcomes for major studies

CASS 4 years 88%(surgical) and 63% (medical)
VA 3 yeas 84% (surgical) and 60% (medical)
ECSS 3 years 93% (surgical) and 81% (medical)

22

Lose 700 cc blood over 30 minutes when on CPB. List 4 possible reasons for loss

volume in pleural space
aortic dissection
retroperitoneal hematoma
Bleeding at cnnulation site
Vasodilation, secondary to plegia/druga
Aggressive diuresis

23

List 3 indications for surgery for chronic AI

Symptomatic patients (NYHA III or IV)
asymptomatic patients with LVEF < 50%
patients undergoing CAD or surgery of ascending aorta

Class IIa
asymptomatic patients with EF > 50% with severe LD dilation LVEDD > 70 mm or LVESD > 50 mm

24

4 complications of Endovascular stenting of descending aortic aneurysm

Aortic rupture
endoleak
stent migration
paraplegia

25

What is the Ratelli procedure

Performed for procedures such as
d-TGA
DORV and VSD
RVOTO

It consists of the a Gore Tex patch that directs oxygenated blood from the left ventricle to the aorta,while at the same time closing the VSD. The pulmonary valve is surgically closed and an artificial conduit and valve are constructed from the right ventricle to the pulmonary bifurcation

26

What are factors to consider when performing endovascular stenting

Adquate landing zone
Non tortuous aorta
Appropriate vascular access
Normal aorta of normal size at proximal neck
Normal aorta of normal size at distal neck
Absence of thrombus at landing zone

27

High vent pressure/return while on pump
List 3 causes
How would you exclude them
What would you do

Bradycardia
V.Fib/tachy
Aortic valve insufficiency
Distortion of heart/secondary incompentence of valve

repair the aortic valve
Pace
Defibrillate
restore heart to normal anatomic position
Arrest and unclamp while venting LV

28

List 8 common post op pulmonary complications

Atelectasis
Pleural effusion
Pneumothorax
Pneumonia
Hemothorax
ARDS
TRALI
Chylothorax
Pulmonary contusion post thoracotomy

29

Etiology that increases likelihood of aortic dissection

Hypertension
Connective tissue disorder/Marfan
Pregnancy
Iatrogenic
Drug use--Cocaine
pre-existing aneurysm
Congenital valvular abnormalities

30

What chamber is not well perfused with retrograde

What percentage returns to the right ostia, left, and RV

Right ventricle

Right ostia = 5-15%
Left ostia = 70-80%
Thesbian veins

31

Describe the Konno operation

Longitudinal aortic incision on the anterior wall
Incision continue to the left of the right coronary artery
across the aortic annulus
into the right ventricle below the pulmonary valve
into the interventricular septum
Ellipitcal piece of dacron to close the septal defect
place the valve
Close the aorta with a patch

32

What are current LDL, Choleserol and HDL ration for patients with CAD

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33

What test would you perform for myocardial contusion? What therapies? New murmur is detected?

TTE
Telemetry for 48 hours

2 Therapies
Supportive
IABP
Telemetry
Watch for mitral valve rupture and tricuspid rupture

34

What are hemodynamic effects of IABP

Left ventricle systolic pressure----Decrease (afterload reduction)
Left diastolic pressure-------decrease (ventricular empyting is enhanced)
Aortic diastolic pressure---increases (balloon augmentation)
Aortic systolic pressure---decreases (after load reduction)

35

How does plavix work

Inhibits platelet aggregation

Inhibits ADPs ability to bind to the platelet receptor (P2Y12) and the ADP mediated activation of GPIIb/IIIa complex. This is irreversible.

36

What is mechanism of LMWH

Inhibits both factor Xa and thrombin
Not reversed with protamine and does not affect PTT and ACT

37

What is mechanism of HIT

severe immune mediated drug reaction.
Heparin binds to platelet factor 4 forming a highly reactive antigenic complex on the surface of platelets.
Patient then develops an antibody (IgG) to the heparin/PF4 antigenic complex
Antibody activates the platelets via Fc receptors
Thormbocytopenia develops

38

4 things in sequence for treatment of anticoagulation

Stop all Heparin
Start
Argatroban
Danaparoid
Lepirudin
Warfarin after several days
TTE

39

3 Ways that retrograde perfusion avoid neurologic injury

Washes out debris from arterial system
Improved cooling of the brain
improved nutritions of the brain

40

4 potential benefits of off pump CABG

Decrease whole body inflammatory response
smaller heparin dose
less hemodilution
shorter LOS
Shorter ICU
fewer pulmonary complications

41

List the cardiac manifestations of carcinoid syndrome

Carcinoid heart disease is reported in approximately 50 to 60% of all patients with malignant carcinoid syndrome
occurs on the right side of the heart
Fibrous deposits adhering to the surface of the valvular endocardium
thickening of the endocardium of the cardiac chambers and papillary muscle and deformation of the valve cusps and chordae tendinae. Can result in combined diseases
Tricuspid valve is affected most commonly

42

Different ways to identify calcified aorta

CXR
CT scan
Epiaortic Scanning
Digital palpation

43

Techniques to repair mitral valve

Chordal transfer
Neochords
Triangular resection
Chordal shortening
Alfieri stitch
leaflet extension

44

3 characteristics of ASD not amenable to Amplatz device closure

Rim insufficient to allow proper seating (minimum is 5 mm)
Large ASD
maximum 20 mm
Small body wight < 10 kg
Ostium Primum

45

Why close an ASD to avoid decompression sickness

Scuba diving can cause formation of inert bubbles that collect.
Formed in venous system and crosses into arterial system through ASD
Two types
I: emboli around skeletal join, knees, elbow, and shoulders
II: progress of type I to involve CNS and CVS

46

What are principles of surgery for constrictive pericarditis

Sternotomy
On or Off pump
Release ventricles from the densely adherent adhesions
Phrenic to phrenic anteriorly and posteriorly--from entrance of vena Cava and pulmonary veins to diaphragm

47

What is the Duke Criteria for Endocarditis
Major:

Minor:
Predisposing condition
fever
immunological
Oslers
Roth spots
vascular
janeway
septic emboli
echo not meeting critieria
mircobiologic phenomena

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48

Define classifications of Aortic Dissections

Stanford A: involving the ascending aorta
Stanford B: dissection limited to the descending aorta, not involving the ascending aorta

Debakey I: involving the ascending aorta and extending into the descending aorta
Debakey II: dissection involving only the ascending aorta
Debakey IIa: dissection limited to the thoracic descending aorta
Debakey IIb: involving the whole descending aorta

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