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Flashcards in Previous Exam 2005 Deck (54):
1

4 etiologies for high line pressure when on bypass

partial outflow obstruction
malpositioning cannula
partial clamping of cannula
kinking of cannula
aortic dissection

2

List 4 reasons why you have to tell patient about a life threatening illness that wife doesn't want you to tell

beneficience
autonomy
justice
nonmalficience

3

Pt with coarctation repair at age 5. Now with pseudoaneursyn of 8 cm distal to left subclavian.
What was the method of the first operation
What are 4 ways to prevent paraplegia

likely a patch aorto-plasty
other options
resection with end to end anatomosis
resection with insertion of interposition graft
patch aortoplasty
subclavian-flap aortoplasty
4 ways to prevent paraplegia
CPB with hypothermic circulatory arrest
reattachment of thoracic and segmental intercostals and lumbar arteries (T8-L1)
sequential aortic clamping
CSF drainage
left heart bypass
measurement of sensory and motor evoked potentials.

4

List 5 complications of coarctation repair

recurrent larnygeal nerve injury
paraplegia
chylothorax
Horners sydrome
re-coarctation
anastomotic aneurysm

5

28 year old with transected aorta in MVC. Discuss appropriate for
Open repair
Stenting
Delayed repair

Open: recommended in stable patients not requiring laparotomy, craniotomy, or pelvic stabilitzation. If no other life-threatening injuries, it is the gold standard

Stenting: maybe used to those who cannot undergo immediate open repair. avoids heparin. allows patients to undergo simultaneous repair, avoids single lung

Delayed repair

6

Patient with moderate to severe secondary TV going for MV operation
What would do you to TV
if TV is secondary and modearte what are some things that will sway you towards not repairing the TR

Indications
Severe primary or secondary TR in symptomatic pts not responding to meds
severe TR in pts underging MV surgery
mild or moderate TR in patients with dilated annulus (> 40mm)

Would not operate if there is
absence of RV dilation
absence of RV dysfunction
emergent OR for acute MR
if repair is not feasible and you would have to replace

7

Trauma pt with large L pleural effusion. CT drained 2L of milky fluid
What is diagnosis
What 3 tests would confirm
2 ways to treat medically
3 ways to treat surgically

Chylothorax
Fluid for chylomicrons, high TG, lymphocytes

Medical treatment
TPN + NPO
Medium-chain fatty acids
octreotide
Surgical treatment
thoracic duct ligation--between 8 and 12th thoracic vertebrai--usually through right chest
pleurodesis
pleuroperitoneal shunt

8

List 4 post acute MI complications that are amenable to immediate surgical repair

ischemic MR
Ventricular rupture
Ischemic VSD
LV aneurysm (false and true)
cadiogenic shock

9

List 4 findings on stress thallium that can predict high likelihood of future events

Pulmonary captation (?)
reversible LV dilation
mult-teritory involvement

10

Pt with 20% EF with LM and LAD disease. No angina. Symptoms of CHF.
What would you like to know about the myocardium
List 3 tests that can be used to predict benefit from revascularization

Viabilitity studies---assess if hibernating myocardium

Thallium, PET, MRI, Dobutamine

11

Uneventful MVR in a female. POD # 2 sudden arrest on ward. After chest compressions, she regains consciouness with no neurologic deficit. HR and BP are normal. EKG 1st degree AV block

3 possible causes

Tamponade
Arrhytmias
valve thrombosis/dysfunction
vaso-vagal
stroke
TIA
transient ischemia

12

List echo findings of ischemic MR

Papillary muscle displacment (posterior and inferior)
Ventricular dilation
Seagull deformity of anterior leaflets
annular dilation (posteior dilation)
leaflet tethering

13

Classification of Mitral valve pathology

.

14

Female pt with 21 aortic bioprosthesis. Under what indexed EFO do you expect PPM

What percentage of patients with PPM will experience residual symptoms
What percentage of these patients will experience improvement in 1-2 NHYA classes

0.85cm2/m2 for mismatch. Severe is .65cm2/m2

30% of patients with PPM will have residual symptoms

15

List 3 most common non myxomatous cardiac tumors

lipoma
papillary fibroelastoma
hemangioma

rhabdomyoma * in kids*

16

Common malignant tumors

angiosarcoma
rhabdomyosarcoma
meotheliomo
fibrosacroma

17

With respect to aortic root enlargement procedures
Describe the incision of a Nicks

How is manougian different

How much annular diameter would you get from these techqniues

Nicks--through the non-coronary sinus into annulus

Manougian
in comissure b/w LCC and NCC and continues down to anterior leaflet of mitral valve
1 valve size (2mm) for a Nics
2 sizes (4mm) for Manourgian

18

List 5 cath findings of constrictive pericarditis

equalization of pressures (LVEDP and RVEDp are within 5 mmHg)
elevation of mean atrial pressure (> 10 mmhg is suggestive of tamponade or constriction)
square root sign (on ventricular pressure tracing: gradual onset of diastolic filling is interrupted by an abrupt dip as the ventricle encounters constrictive pericardium)
prominent Y descent (in right atrial tracing)
elevated RVEDP (> 1/3 RVESP)
left ventricular ejection fraction is > 40%

19

Patient with post op AF and cannot tolerate meds. List 3 other options

Cardioversion
ablation with pacing
OR for maze

20

Pt with an intramural hematoma. What is the definition and etiology? What is the natural history? How would you treatm?

Collection of blood in the media of the aortic wall without flap or flow

etiology--rupture of vaso vasorum or penetraiting atherosclerotic

Natural history--33% mortality for ascending aorta, 9.7% for descending aorta
If anasecnding aorta then treat like a type A. if in descending then treat like a type B

21

What are options for ascending aortic dissection with moderate AI

Bentall
Supracoronary tube graft
Aortic valve repair (reimplantation vs remodeling)

22

Describe mechanism of action and the role of spinal cord stimulation in the treatment of angina

Stimulation of the dorsal aspect of the T1 and T2 spinal cord suppresses pain associated with myocardial ishcmia by modulation of activity of intrinsic cardiac neurons.

23

Five year old patient with ASD. List 4 situations that would preclude percutaneous device closure

If not a secundum--ASD or PFO
Other anomalies requiring heart surgery
orifice must be wide enough to accomadate the deice
adquequate rim
access vessels not large enough to accmodate shearth

You need to close an ASD in a patient with decompression illness because after treatment in hyperbaric chamber for decompression there is a increased risk of pardoxical emboli.

24

TOF repair with anomalous vessel crossing RVOT from right to left.

What is it?
List 3 options of dealing with this scenario

Anomalous LAD

Options
transatrial transeptal approach is usually effective, allowing a short transannular patch
RV-PA conduit
The extent of the RV ventriculotomy will be limited
palliative shunt

25

Name 4 classes of meds that all patients post CABG should be on

Beta-Blocker (metoprolol)
Statin
ACE
Anti-platelet agetn

26

List 3 classes of anti-thrombotic meds used in acute coronary syndrome

GPIIb/IIIa--abciximab--repro
tirofiban (aggrastat)
eptifibatide (integrelin)
ASA
Clopidogrel

27

List 5 absolute contraindications to the use of a donor heart

Age
Presence of the follow
prolonged cardiac arrest
prolonged severe hypotension
preexisiting cardiac disease
intracardiac drug injection
sepsis
positive serologies of HIV, Hep B, Hep C

28

List 5 indications for severe, chronic MR

symptoms
EF < 60% with LVESD > 45mm
recent A fib
PHTN
EF < 30% _ LVESD > 55m in whom chordal presevation is highly likely.

29

List 4 physiologic changes that occur during pregnancy

increased blood volume
increased red cell mass
increased heart rate
decreased peripheral vascular resistance
increased cardiac outout
decreased BP
caval compression
hypercoagulable state

30

List 4 absolute contraiidcations to TEE

tumor
Recent suture lines
Diverticula
C spine injury (C1 and C2 degernation)
esophageal stricture

31

Definitions of types of heart transplants

Orthotopic: removal of recipients heart, replacement with donor heart
Hetertopic: recipients heart is conserved for severe PHTN, RV failure

32

List 2 options for implanting a PPM in a patient with mechanical ticuspid valve

coroanary sinus
epicardial
around the valve annulus

33

What are boundaries of triangle of kock

tendon of tordaro
septal leaflet of tricuspid valve
coronary sinus

34

List 3 mechanisms of how LV aneurysms cause LV dysfunction

Increased wall tension: increased MVo2
loss of LV synchrony for organized contraction
spherical shape

35

Review definitions of heart transplant biopsy

Definition of grade 1A rejection: Focal inflammatory infiltrate: repeat biopsy.

36

What is diastolic dysfunction

What are risk factors for diastolic dysfunction

refers to disturbance in ventricular relaxation, distensibility or filling. Regardless of whether the ejection fraction is normal is depressed


Hypertension
Unstable angina
old age, female, diabetes, CAD

37

4 treatments of diastolic dysfunction

slower heart rate
PDI inhibitors
improve filling pressures
AV synchrony
afterload reduction

38

Define Crawford I, II, III, and IV aneurysms

Crawford I: left subclavian to renal arteries

Crawford II: Left subclavian to Iliac arteries

Crawford III: Mid descending thoracic aorta to iliac arteries

Crawford IV: supraceliac aorta (below diaphragm) to iliac arteries

39

4 advantages of internal mammary artery skeletonization

length
less neuropathy
easier sequential
flow increased
less pain

40

Define Structural valve dysfunction

any change in function (decrease of one NYHA functional class or more) of an operated valve resulting from intrinsic abnormality of the valve that causes stenosis or regurgitation

41

Define valve thrombosis

any thrombus, in the absence of infection, attached or near an operated vavle that occludes part of the blood flow path, or that interferes with the function of the valve.

42

List 3 options for the management of an ischemic leg in pt with IABP.

Remove IABP and switch to other side
embolectomy/local reconstruction
Fem-Fem bypass

43

5 indications for early operative intervention for type B dissection

Pain unresponsive to treatment
refractory Hypertension
Malperfusion
Sizable false aneursym
Aortic rupture pending??

44

Define alpha stat

Adding CO2 because pH adjusted to temperature during cooling. Results in improved cooling.

45

Define alpha stat

pH measured at 37 decreases and not adding CO2

46

What investigations are important for patient thromboembolic disease on pulmonary function testing

Diffusing capacity is often reduced

Most patients have room air arterial oxytension between 50 to 85toor.

Co2 tension is reduced and compensated by reduced HO3

47

List 5 steps of management for 3rd time redo when gush of dark blood occurs

Reclose chest
Expose femoral vessels
Heparin
Cannulate arterial and vein and start CPB
Re-open sternum with suction, relieve tension, dissect, and repair

48

List 4 mechanisms of neurologic injury on CPB

Mirco-emboli (air bubbles, fat dropplets)
Marco-emboli
Hypoperfusion
Ischemia
Inflammatory
Intracranial bleeding

49

Patient in cath lab has a dissection. What is management?

Would do surgery ASAP

Keep heparin on to the OR. If on plavix then ask for platelet.

If possible delay for 5 days

50

Pertaining to AS

Normal AVA 3- 4 cm
Mild AS 1.5 to 3
Moderate 1.0 to 1.5cm2
Severe < 1 cm2

51

Pertaining to rate responsive pacemakers what are 5 variable that they can sense

Heat
Resp rate
Body vibration
QT interval
RV stroke volume
Intracardiac pressure
CO2
lactic acid
Svo2
RV stroke volume

52

What is advantage of pH statt

Increased CBF compared to alpha stat
preferential in children
allows uniform cooling of the head
Rate of brain oxygen depletion during DHCA is slower

Disadvantage
addition of CO2 may lead to brain acidosis and CNS injury during rewarming
increased CBF might increase the cerebral embolic load
decreased ability to maintain autoregulation at low pressures

53

what is advantage of alpha stat

may provide the greatet cerebral protection during hypothermia for adults
easier

54

25 year old drug addict with high fever
Name 2 diagnostic tests
What valve is most likely involved
5 indications for surgical intervention in TV endocarditis
4 surgical options
Most common organism

Transthoracic echo and Blood cultures
Triscuspid
5--multiple emboli after appropriate abx; uncontrolled sepsis; large vegetation; evidence of abscess; onset of conduction disturbance; symptoms of right heart failure; large vegetation

4 surgical options
local excisoin of vegetation and pericardial patch
bicuspidization
excision of tricuspid valve
tricuspid valve replacement
most common organism is staph aerus

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