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Flashcards in Previous exam 2008 Deck (22):

List 2 cannulation strategies and associated methods by which you can give antegrade cerebral perfusion.

List nasopharyngeal temp you want and rates and pressure

Axillary cannulation

direct cannulation of the head vessels with special balloon catheters once the arch is open

Target temp is 15-20 degress

perfusion rate is 10-15ml/kg/min ( 700 to 1500ml/min) HCT 25%

cerebral perfusion pressure is measured via the radial arterial line


LVAD implant in a patient with cardiogenic shock who had a previous CABG. Now is Hep, ASA, and POD hypotension and CVP is 15 and flow in LVAD poor. List 3 causes and treatment

Tamponade: To OR for evaculation of clot
Hypovolemia: Needs volume resuscitation
RV failure: needs inotropic support and maybe RVAD


List 3 tests you would perform for a patient with purulent pericarditis and 3 treatments

pericardial friction rub
elevated JVP
pulus paradoxus (> 10 mmHg decrease in systolic pressure on inspration
Kussmauls sign (increase in JVP in inspiration

Gram stain and culture

Draingage and anti-microbial


Young CABG diabetic who plans for all arterial. No SVG. 90% LAD; 60% RCA; and 90% circumflex. what grafts

left radial to circumlex
free LIMA to RCA

risk of mediastinitis 10% if IMA is pedicled and 2.2% if skeletonized


7 day old baby who presents with failure, has systolic murmur, weak femoral pulses

hypoplastic arch
interrupted arch
severe AS/subaortic stenosis

treat metabolic acidisosis
surgical repair of lesion


3VD with poor left ventricular function. List 5 independent predictors of increased mortality in this patient CABG surgery

urgency of operation
number of previous surgeries?
increasing age
Left ventricular ejection fraction
% stenosis of leaf main
number of diseased vessels with > 70% stenosis


BNP--List 3 things it does physiologically and when and where is it secreted

Brain natriuretic peptide

Natriuesis/Diuresis/decrease myocardial fibrosis and remodeling
improve myocyte relaxation during diastole
inhibit renin-angiotensi system

some secreted in brain but most in ventricles.

higher levels in CHF, ACS, and pericarditis


48 year old F with asymptomatic severe AI. List 4 echocardiographic features that would make you opearate

EF < 50%
LVESD > 55ml
LVEDD > 75
Dilated ascending aorta (>5 in marfa and > 5.5 in others


Ebstein's anomaly. List the 4 pathological findings with the tricuspod valve and annulus

Displacement of spetal and posterior leaflet towards the RV

arterialization of the RV segment between the true trucuspid annulus and the new position of the leaflet attachment

small RV

anterior leaflet that maybe large, sail like or restricted in motion


List 3 alternatives to heparin for HIT



Adult with undiagnosed PDA has eisenmengers syndrome now. What are 2 surgical options to treat this patient now

Heart lung transplant

Lung transplant


REMATCH trial list the actuarial survival of the medical therapy group

1 year: medical 25% device 52%
2 year: medical 8% device 23%


In ischemic MR list 3 beenfts of annuloplasty on the mitral valve

Prevents further annulus dilation and helps in LV remodelling
Reduces the size of the annulus allowing better copatation of the leaflets
relives tensions from the suture lines
Decrease MR
Prevent annular dilation
Restore leaflet coaptation


What are types of endoleaks

This is Type 1.
Type 2: leak from flow outside the graft
Type 3: leak from graft tear or defect
Type 4: leak from porous graft
Type 5: leak from endotension


What is intramurual hematoma

Accumulation of blood in the media of the aorta without the presence of any flow, resutling from bleeding of the vasa vasocrum into the media

1/3 develop into aortic dissection

ascending should be treated like type A dissection

decending treat medical


List most common causes of death in transplant patients at 0-30 days; 31-1 year; and > 5 years

0-30--most common is acute graft failure

30-1 year: infection

> 5 years: chronic allograft vasculopathy


List mechanisms of reperfusion injury

i) oxygen free radicals
ii) intracellular calcium overload
iii) endothelial & microvascular dysfunction
iv) altered myocardial metabolism
v) Platelet, neutrophil, & complement activation


Question on Sano shunt vs. modified BT shunt in Norwood operation and when blood flow occurred in coronaries and pulmonary arteries in both shunt. Gave you a 2x2 table and had to fill in boxes. Options were diastole, systole, or both.

Coronaries PA
Sano Both Systole
Modified BT Both Both


Cardiac resynchronization therapy question in patient with dilated cardiomyopathy. List 2 reasons why it would fail. Long question can’t remember all the details of the question.

Lead malpositioning
Lead fracture
Loss of capture
Cardiac perforation
Battery end of life
Inadequate LV/RV synchronization


Patient with dilated cardiomyopathy (EF<20%). Has been on “state of the art” meds. Now patient has NYHA class 3-4 failure. List 4 “state of the art” meds patient was on. List 4 non-medical treatment options for this patient.

beta blocker, ACEI, spironolactone, digoxin
CRT, CABG if pt has CAD, LVAD as destination therapy, transplant, ICD


In patient with 3VD and poor LV fxn. List 5 independent predictors of increased mortality in this patient with CABG surgery

Old age
Poor LV function
Preop renal failure
Cardiogenic shock
Emergency status


intra-operative dissection occurs post ascending aortic aneurysm repair. List 3 immediate steps

Expose femoral vessel and cannulate the right common femoral artery. Change in-flow to the femoral cannula and go on bypass and cool to 20C.

DHCA to 20 degrees, pack head with ice, mannitol, circulatory arrest, trendulburg

Bring down distal anastomosis and expose aortic arch. Identify the intimal tear and resect. Bring together the intimal tear and the aortic wall with teflon felt and reconstitie the true lumen.

Recannulate with side arm the distal graft and retart CPB.

Trim and perform end to end graft.

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