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Spring- Final Exam Flashcards

1
Q

what do platelets Alpha and Dense granules contain

A

Alpha granules: clotting factors, growth factors, and various other proteins
Dense granules: ADP, ATP, Serotonin, and Calcium

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2
Q

what is platelet rich plasma (PRP)

A

The components of whole blood remaining after the removal of (most of) the red cells
-The buffy coat (white cells and platelets) extending into the top of the red cell column PLUS all of the plasma

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3
Q

what is platelet poor plasma (PPP)

A

Plasma layer without the buffy coat- So…you get lots of fibrinogen and coagulation factors but no cells

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4
Q

what is in the buffy coat

A

WBCs and platelets

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5
Q

what is platelet get

A

it is Platelet Concentrate with enough fibrinogen (2-4mg/ml) to “set up” when combined with an activator

  • -“Activator” = Thrombin (bovine or human), Calcium (usually CaCl₂) or Collagen
  • -Platelets 2-6x over baseline
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6
Q

platelet get promotes healing in virtually all tissues except?

A

Nervous tissue

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7
Q

where can you never ever apply platelet gel

A

coronary grafts

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8
Q

where are 2 places that stem cells can be harvested from

A 
Bone Marrow (“Mesenchymal”) Derived
Adipose Tissue Derived
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9
Q

what is the normally required cerebral metabolic requirement for O2 (ml/min) and cerebral blood flow (ml/min)

A 
CMRO2= 50ml/min
CBF= 750 ml/min
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10
Q

at what temperatures does cerebral flow-metabolism coupling disappear

A

below 22C

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11
Q

why is pH stat better for pediatrics

A

increased CO2 causes dilation- so you have to increase flows to maintain MAP (and bc you lost flow/metabolic coupling). Peds can use the extra flow bc they do not have acquired disease like adults so stroke from embolism is not really a worry

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12
Q

describe the blood flow path for Antegrade Cerebral Perfusion. what is the flow rate?

A

blood flows up the axillary to the innominate to the right common carotid thru the circle of willis and down the jugular veins to the SVC- you have to leave the venous line open to drain the heart.
-Flow at 10 ml/kg/min (so a 70kg patients flow is 700ml/min)

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13
Q

describe the blood flow path for Retrograde Cerebral Perfusion. what is the flow rate?

A

blood flows up the SVC thru the circle of willis and down the carotid arteries
-Flow below 500 ml/min

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14
Q

what are the 2 indications for a VAD? describe each

A
  1. Bridge to Transplant: worsening hemodynamics despite high level of inotropic support
  2. Destination Therapy: Not transplant canidates, have EF less than 25% and are NYHA Class 4
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15
Q

describe the Thoratec PVAD:/IVAD

  • Stroke Volume:
  • BPM range:
  • Flow range:
  • BSA requirement:
  • How it works:
A
  • Stroke Volume: 65ml
  • BPM range: 40-110
  • Flow range: 1.3- 7.2
  • BSA requirement: above 0.73 m2
  • How it works: alternates pos and neg air pressure by a console/portable driver
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16
Q

what are the 5 pump considerations for Thoratec VAD implantation

A
  1. Bi-caval cannulation is ideal
  2. Stay normothermic
  3. No CPG or XC
  4. Use an LV Vent
  5. Hemoconcentrate to keep the Hct above 30
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17
Q

whats the difference btwn Thoratecs PVAD and IVAD

A

PVAD: can be used for peds since it is paracorporeal
IVAD: fully implantable, longer support, reduced weight

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18
Q

describe the Heartmate XVE

  • Stroke Volume:
  • Flow range:
  • BSA requirement:
  • type of pump:
  • cannulation sites:
A
  • Stroke Volume: 83ml
  • Flow range: 4-10 lpm
  • BSA requirement: above 1.5 m2
  • type of pump: Positive displacement
  • cannulation sitess: LV apex and Ascending aorta
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19
Q

what are the 4 pump considerations for the Heartmate XVE implantation

A
  1. AI, MS and PFOs must be corrected at implantation
  2. Stay normothermic
  3. No CPG
  4. The bearings wear out in 18-24 months
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20
Q

describe the Heartmate 2

  • Flow specifications:
  • type of pump:
  • cannulation sites:
A
  • Flow specifications: Flow is an estimate and is not accurate below 3 lpm
  • type of pump: Axial Flow- centrifugal
  • cannulation sites: LV apex and Ascending Aorta
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21
Q

describe Terumos DuraHeart LVAS:

  • Flow range:
  • RPM range:
  • type of pump:
A
  • Flow range: 2-8 lpm
  • RPM range: 1200-2400 rpms
  • type of pump: Rotary
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22
Q

describe the Levacor VAD:

-type of pump:

A

-type of pump: bearingless centrifugal pump

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23
Q

describe the Abiomed Impella 2.5/5.0 VAD

  • Flow range:
  • type of pump:
A
  • Flow range: 2.5 - 5.0 lpm

- type of pump: intracatherter VAD

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24
Q

describe the Abiomed Abiocor

  • Flow range:
  • type of pump:
A
  • Flow range: up to 12 lpm

- type of pump: 1st completely contained replacement heart. Has an internal motor and internal rechargeable battery

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25
Q

describe the Tandem Heart

  • Flow range:
  • type of pump:
A
  • Flow range: up to 8 lpm (cannula size dependent)

- type of pump: 10 ml centrifugal pump- floats on fluid bearings

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26
Q

describe the Syncardia TAH

  • Flow range:
  • type of pump:
A
  • Flow range: up to 9.5 lpm

- type of pump: pneumatic driver

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27
Q

describe the length of the ascending aorta

A

from the AV annulus to the innominate artery

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28
Q

describe the length of the transverse aortic arch

A

btwn the 3 head vessels

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29
Q

describe the length of the descending aorta

A

from the left subclavian to the diaphragm

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30
Q

describe the length of the abdominal aorta

A

from the diaphragm to the femoral bifurcation

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31
Q

what is the difference btwn a dissection and an aneurysm

A
  • dissection: tear in the intima creating a false lumen

- aneurysm: dilation of all 3 layers

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32
Q

what is propagation of a dissection driven by

A

pulse pressure and ejection velocity

-occurs w/in seconds

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33
Q

describe the DeBakey classifications of aortic dissections

A
  • Type 1: Tear in the ascending aorta that extends all the way down to the femoral bifurcation
  • Type 2: Tear in the ascending aorta that stops at the innominate artery
  • Type 3A: Tear in the descending aorta that stops at the diaphragm
  • Type 3B: tear in the descending aorta that extends below the diaphragm
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34
Q

describe the Stanford classifications of aortic dissections

A
  • Type A: any involvement of the ascending aorta

- Type B: any involvement of the descending aorta

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35
Q

describe the 2 classifications for aneurysms by shape

A
  • Fusiform: entire circumference of the aortic wall

- Saccular: involves only part of the circumference of the aortic wall

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36
Q

what shape classification do arch aneurysms usually appear

A

Saccular (involves only part of the circumference of the aortic wall)

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37
Q

describe the Crawford classifications for aneurysms

A
  • Extent 1: Descending aorta to the renal arteries
  • Extent 2: Descending aorta to the femoral bifurcation
  • Extent 3: Bottom half of the descending aorta to the femoral bifurcation
  • Extent 4: Abdominal aorta
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38
Q

what are the 1st and 2nd most common aneurysm rupture locations

A
  1. Distal to the left subclavian artery

2. Distal to the Aortic Valve

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39
Q

describe left heart bypass

A

Used for descending legions (blood is shunted around the aneurysm/dissection

  • Venous cannula goes in LA
  • Arterial cannula goes in descending aorta
  • Heart still pumps blood to the lungs and lungs still oxygenate
  • Circuit: tubing and centrifugal pump (no reservoir, HE or bubble trap)
  • Only anesthesia can give volume
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40
Q

describe Marfans Syndrome

A
  • Connective tissue disorder
  • Causes weakened arteries- especially the aorta
  • At risk for aneurysms/dissections/MV prolapse/AI
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41
Q

describe 3 criteria for patient selection of a heart transplant

A
  • end stage CHF
  • NYHA Class 3 or 4
  • EF
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42
Q

name 6 possible contraindications for a heart transplant

A
  • Irreversible pulmonary HTN
  • Active infection
  • Obesity
  • Diabetes
  • Psychosocial (substance abuse/social support)
  • old age (although physiologic age is better than chronologic)
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43
Q

what are the 5 things that are looked at while organ matching

A 
ABO Blood Compatibility
Antigen Cross Matching
Body Size (must be w/in 20% body weight)
Priority on UNOS Registry
Geographic Distance
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44
Q

describe donor heart procurement? what is the ideal ischemic time?

A
  • donor heart is arrested with CPG
  • atria are transected at mid atrial level
  • aorta and PA are transected just above the valves
  • heart is cooled topically
  • Ischemic time is 3-4 hours (can do 5-6 hrs but thats not ideal)
  • perfusion records the donor XC time (ischemic time)
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45
Q

describe how a donor heart is placed in the recipient

A
  • atria are re-attahced (SA node is included)

- aorta and PA are re-attached just above the valves

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46
Q

what are the 6 pump considerations for a heart transplant

A
  1. Document donor XC (ischemic) time
  2. Drift or cool to 32C
  3. XC patient- no CPG
  4. Heart is sewn in
  5. Rewarm
  6. Some places give a hot shot dose of CPG
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47
Q

when doing DHCA, what do you have to do before clamping off the arterial line

A

give mannitol 12.5g

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48
Q

describe the Transmedics Organ Care System (Heart in a Box)

A
  • kept at normal body temp
  • beats w/ warm oxygenated blood in a sterile box
  • prolongs time btwn removal and transplantation and decreases injury while ischemic
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49
Q

name 2 indications for a lung transplant

A

irreversible end stage pulmonary disease

life expectancy less than 18 months

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50
Q

what are the 4 types of lung transplants

A
  1. Single
  2. Double (En Bloc and Bilateral Sequential)
  3. Heart-Lung Block
  4. Ex-Vivo Lung
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51
Q

when doing a single lung transplant, is the left or right side easier?

A

Left

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52
Q

When is perfusion involved in single lung transplant?

A

If the patient does not tolerate unilateral support during the XC then the patient is placed on fem-fem CPB

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53
Q

what are the pump considerations for a single lung transplant

A
  • usually stay warm
  • native lung is excised and LA is clamped
  • PVs are attached to LA cuff and PA is attached
  • Bronchus is attached and LA clamp is removed
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54
Q

in regards to double lung transplant, what is the difference btwn En Bloc and BiLateral sequential methods

A
  • En Bloc: Each lung is implanted separately through a pleural-pericardial window while on CPB
  • BiLateral Sequential: Like 2 single transplants (ventilate native lung while first goes in then ventilate new lung while second goes in)
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55
Q

describe Ex Vivo lung transplantation

A
  • Therapy is applied to donor lungs outside the body before transplantation- this improves organ quality (makes lungs that were previously unsuitable for transplantation safe)
  • 3-4 hr procedure: Lungs are placed in a plastic dome, ventilated and kept at normal body temps. Treated with a bloodless solution full of nutrients and oxygen
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56
Q

describe how liver transplants are performed

A
  • donor organ arrives and is inspected
  • incision is made in patient
  • test clamp is performed- if the patient does not tolerate this then they are placed on VV CPB
  • liver is sewn in (Supra/Infra IVC, Portal Vein, Hepatic Artery)
  • clamps are removed and CPB is stopped
  • Bile duct is sewn in
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57
Q

what are the pump considerations for a liver transplant

A
  • VV CPB (no oxygenator or reservoir)
  • flow range: 1-2 lpm
  • cannulate femoral vein and portal vein wyed together for outflow- returned via the axillary or jugular vein
  • No heparin
  • closed system (so we cant add volume)
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58
Q

define percutaneous transluminal coronary angioplasty (PTCA)

A

balloon is advanced to the level of the blockage- balloon is inflated- plaque is pushed back against the vessel wall and the artery is stretched

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59
Q

define stenting

A

balloon is advanced to the level of the blockage- balloon is inflated- stent is deployed

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60
Q

when can coronary angioplasty not be used

A

can not be used for the left main coronary artery

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61
Q

what are artherectomy devices

A

actually removes plaque material

often used in adjuct w/ PTCA or stents

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62
Q

define Transluminal Angiogenesis (aka Transmyocardial Revascularization)

A

uses a CO2 lase to make 20-40mm channels in the myocardium- this promotes growth of new small vessels

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63
Q

Name 3 types of percutaneous Aortic Valves

A

Edwards: Sapien
Medtronic: CoreValve
Sorin: Perceval

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64
Q

Name 1 type of percutaneous Mital Valve

A

E-Clip

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65
Q

name the name of the cell savers from each company:

  • Haemonetics:
  • Medtronic:
  • Sorin:
  • Cobe:
  • Terumo:
A
  • Haemonetics: Cell Saver 5 and Elite
  • Medtronic: Autolog
  • Sorin: Xtra
  • Cobe: BRAT
  • Terumo: CATS
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66
Q

after blood is washed, can you give it back to the patient straight from the cell saver bag

A

No. It must be filtered into a transfer pack

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67
Q

name 3 types of anticoagulants that cell savers can use

A

Heparinized Saline (30,000 units/ 1 liter saline)
CPD (citrate-phosphate-dextrose)
ACD-A (anticoagulant citrate dextrose)

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68
Q

whats the difference btwn cell saver Latham and Bailor bowls

A

Latham: Angled sides
Bailor: Straight sides

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69
Q

what is special about the CAT autotranfusion device

A

it uses a Disk (instead of a bowl) so that blood can be washed and emptied at the same time

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70
Q

in regards to cell savers, when is the Fill Phase complete

A

when the Buffy Coat reaches the shoulder of the bowl- then it moves to the washing phase

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71
Q

in regards to cell savers, when is the Wash Phase complete

A

when the predetermined amount of wash solution has been used OR someone pressed the reinfuse/empty button (you can do this when the effluent line turns clear)

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72
Q

After the cell saver washes a bowl and you transfer the blood to a reinfusion bag- how long do you have to give it to the patient before it expires

A

4 hours

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73
Q

After the cell saver washes a bowl and you transfer the blood to a reinfusion bag- how do you label it before giving it to anesthesia

A 
Patient sticker
Time collected
Expiration time
Volume
initials
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74
Q

what 10 things do cell savers wash away from blood

A 
Plasma
Platelets
WBCs
Clotting Factors
Anticoagulant Solutions
Intracellular Enzymes
Potassium
Plasma Free Hemoglobin
Plasma Bound Antibiotics 
Cellular Stroma
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75
Q

what are the 4 contraindications for cell savers

A
  • Bacterial contamination at surgical site (blood should be discarded unless surgeon requests it-life emergency)
  • C-Section (bc of the possibility of amniotic solution entering the mothers blood stream causing an embolism)
  • Malignancy of surgical site
  • Topical hemostatic agents (collagen type products)
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76
Q

what is the main disadvantage of using a cell saver

A

it depletes plasma and clotting factors which can cause a coagulopathy when reinfused (treatment with FFP and platelets)

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77
Q

what is the equation for pH

A

-log*[H+]

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78
Q

what 5 systems control pH in the body

A

-Bicarb System (extracellular)
-Phosphate System (extracellular)
-Proteins (intracellular)
-Lungs- control CO2
Kidneys- control [H+] and [bicarb]

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79
Q

what does the posterior pituitary secrete

A

Neuro: ADH (Vasopressin) and Oxytocin

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80
Q

what does the anterior pituitary secrete

A

Tropic Hormones: Adrenal Cortex Hormone, Thyroid Hormone, Growth Hormones, Reproductive Hormones

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81
Q

what are the 6 absolute contraindications for a balloon pump

A
  • Thoracic/Abdominal aneurysm
  • Aortic dissection
  • Severe Aortic insufficiency or regurg
  • Major coagulopathies
  • Brain death
  • End-stage diseases
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82
Q

what are the 2 relative contraindications for a balloon pump

A

Severe aortic atherosclerosis

Peripheral Vascular Disease

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83
Q

what are the 4 goals of balloon pump treatment

A
  1. Increase CO
  2. Decrease myocardial work
  3. Decrease myocardial O2 demand
  4. Decrease myocardial ischemia
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84
Q

describe balloon counterpulsation

A

heart beats during systole

balloon inflates during diastole

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85
Q

when does a balloon pump inflate and deflate

A

inflates during diastole

deflates just before ventricular ejection

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86
Q

what are the triggering options for a balloon pump

A

EKG

Arterial Pressure

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87
Q

describe EKG triggering for a balloon pump

A

maximizes amplitude of the R wave

-make sure to avoid electrical interference

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88
Q

what are some signs of proper timing for balloon pumps

A

assisted diastolic pressure is high and end diastolic pressure is low
-good dicrotic notch is present

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89
Q

what are 2 indicators of early inflation for balloon pumps? what does this cause

A

no dicrotic notch and decreased diastolic augmentation (no time for AV to close)
-causes premature closure of AV, regurg into LV, decreased SV and CO, increased preload and O2 consumption

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90
Q

what is the 1 indicator of late inflation for balloon pumps? what does this cause

A

wide dicrotic notch

-causes a decrease in coronary perfusion

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91
Q

what are 2 indicators of early deflation for balloon pumps? what does this cause

A

assisted end diastolic pressure will be close to the patients and the assisted systolic will be higher than the patients
-causes no afterload reduction, increased preload and increased O2 consumption

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92
Q

what are 2 indicators of late deflation for balloon pumps? what does this cause

A

assisted end diastolic will be higher than the patients and assisted systolic will be higher than the patiens
-causes increase in afterload, prolonged contraction, increased O2 demand, decreased SV and CO

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93
Q

when setting up a balloon pump, which is worse: early/late inflation or early/late deflation

A

Late deflation

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94
Q

what does a balloon pump do if there is an ectopic beat

A

deflates on R wave- then tracks and responds

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95
Q

how does tachycardia effect a balloon pump

A

decreases diastolic augmentation

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96
Q

how does ventricular fibrillation effect a balloon pump

A

balloon turns off

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97
Q

how does cardiac arrest effect a balloon pump

A

auto-mode makes it go off 80 times a minute

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98
Q

how does a pacemaker effect a balloon pump

A

its linked to the pacer and goes at a fixed rate with the pacer

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99
Q

what are the 3 clinical criteria for weaning from a balloon pump

A
  1. Evidence of adequate perfusion (UOP over 30ml/hr, warm skin, improved mental status)
  2. No evidence of CHF (rales and S3 are absent)
  3. No life threatening arrhythmias
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100
Q

what are the 4 hemodynamic criteria for weaning

A
  1. CI over 2.0 l/min/m2
  2. MAP over 70 mmHg (w/ minimal pressors)
  3. LAP below 18 mmHg
  4. HR below 11o bpm (no ventricular arrhythmias)
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101
Q

what are the 3 balloon sizes based on height

A

below 160 cm= 34cc
160- 182 cm= 40cc
above 182 cm= 50cc

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102
Q

how do you manage a balloon pump during CPB

A

pause during cannulation
pause during CPB
turn back on while weaning from CPB (re-zero pressure and re-fill balloon)
(remember not to turn the balloon unless the patient is anticoagulated)

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103
Q

name 4 greatest risk periods for emboli during CPB

A
  • atrial cannulation
  • initiation of CPB (hypotension and spallation debris)
  • XC application/removal (plaque debris)
  • decreased flow w/ a centrifugal pump
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104
Q

whats the mechanism of action that makes lidocaine an antiarrhythmic

A

it reduces cell membrane permeability for Na+ and K+ which increases the stimulation thresholds in the ventricles

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105
Q

whats the mechanism of action for magnesium sulfate

A

it controls the transmembranes electrolyte and energy metabolism (arrhythmias can occur during hypomagnesemia)

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106
Q

how does calcium chloride help the patient

A

improves myocardial contractility
blood clotting
neurotransmission
muscle contraciton

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107
Q

whats the mechanism of action for THAM

A

creates an alkaline environment by combining with hydrogen ions to form bicarb

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108
Q

whats the mechanism of action for Trasylol

A

Serine protease inhibitor: inhibits fibrinolysis

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109
Q

whats the mechanism of action for Thrombate

A

inactivates thrombin and activated forms of Factors 9, 10, 11 ,12 which results in coagulation- used for AT3 deficiency

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110
Q

whats the mechanism of action for solumedrol (methylpredisolone)

A

glucocorticoid used to decrease inflammation (often used during DHCA cases)

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111
Q

define Atelectasis

A

a complete or partial collapse of a lung or a lobe of the lung- develops when the alveoli become deflated and dont inflate properly

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112
Q

what is the functional unit of the kidney? what does the glomerulus and tubular system do?

A

nephron
glomerulus filters
tubular system alters fluid composition

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113
Q

what is the normal Glomerular Filtration Rate (GFR)

A

100-200 ml/min

114
Q

what does a PT/INR measure compared to a PTT

A 
PT/INR= Extrinsic clotting (7, 10, 2)
PTT= Intrinsic clotting (12, 11, 9, 2)
115
Q

what does the ‘R’ tracing represent on a TEG? whats its likely variable?

A 
Reaction time (time of clot formation)
Variable: coagulation Factors
116
Q

what does the ‘Alpha’ tracing represent on a TEG? whats its likely variable?

A

Speed of fibrin accumulation

Variable: Fibrinogen

117
Q

what does the ‘K’ tracing represent on a TEG? whats its likely variable?

A

Time elapsed until clot reaches a fixed strength

Variable: Fibrinogen

118
Q

what does the ‘MA’ tracing represent on a TEG? whats its likely variable?

A

Highest vertical amplitude of the TEG tracing

Variable: Platelets

119
Q

what does the ‘LY30’ tracing represent on a TEG? whats its likely variable?

A

% of amplitude reduction 30 minutes after its max

Variable: Fibrinolysis

120
Q

in regards to TEG: what does an elongated R tracing mean? what is a common treatment for it?

A

Thrombin formation abnormalities

- treat with FFP

121
Q

in regards to TEG: what does a low alpha angle mean? what is a common treatment for it?

A

Fibrinogen abnormalities

- treat with FFP or Cryp

122
Q

in regards to TEG: what does a low MA mean? what is a common treatment for it?

A

Platelet function abnormalities (low plt count)

- treat with platelets

123
Q

in regards to TEG: what does a high MA mean? what is a common treatment for it?

A

Platelet function abnormalities (high plt count)

- treat with anti-platelet agents

124
Q

Embryonic Development: where does fertilization occur? what is the fertilized cell called

A

occurs in the ampullary region of the fallopian tube

-fertilized cell is called a zygote (sperm+oocyte)

125
Q

Embryonic Development: when the fertilized cell makes it to the uterus, what is it called? what is this cell comprised of (layers)?

A

called a Blastocyst

  • Trophoblast (outer covering- becomes placenta)
  • Blastocele (internal fluid filled space)
  • Embryoblast (inner cells mass-becomes embryo)
126
Q

Embryonic Development: during gastrulation, what does the ectoderm, mersoderm and endoderm become

A
  • Ectoderm- Skin/Teeth/Nervous System/Endocrine Glands
  • Mesoderm- Connective, muscular and skeletal tissue/ Lymphatic and Circulatory Systems
  • Endoderm- Epithelium of digestive tract/respiratory system/bladder/vagina/urethra
127
Q

Embryonic Development: when does the cardiovascular system begin to appear

A

middle of 3rd week (becomes functional long before any of the other systems)

128
Q

Embryonic Development: what will eventually become the pericardial cavity

A

Intraembryonic Celom

129
Q

Embryonic Development: how does the primitive heart tube begin to develop? when does it start to beat?

A

Angiogenic cells form clusters called Blood Islands- they increase in size and number, acquire a lumen, form a plexus of blood vessels- then unit to for a common tube called the Primitive Heart Tube
-Starts to beat on day 22

130
Q

Embryonic Development: what congenital defects may occur if the primitive heart tube does not lengthen as it should during development (5)

A 
TOF
VSD
PA
PS
DORT
131
Q

Embryonic Development: during development of the Primitive Heart Tube, what does each section become?

  • Dorsal Aorta & Aortic Sac:
  • Bulbus Cordis:
  • Primitive Ventricle:
  • Atrioventricular Sulcus:
  • Paired Primitive Atria:
  • Sinus Venosus:
A
  • Dorsal Aorta & Aortic Sac: Common outflow tract
  • Bulbus Cordis: Right Ventricle
  • Primitive Ventricle: Left Ventricle
  • Atrioventricular Sulcus: Divides atria from ventricles
  • Paired Primitive Atria: Common atria
  • Sinus Venosus: Coronary Sinus & Oblique Vein of LA
132
Q

Embryonic Development: on what day of is the heart completely developed

A

day 55

133
Q

Embryonic Development: There are 6 pairs of aortic arches present at some point- what do each pair become?

A 
Arch 1: Maxillary Artery
Arch 2: Stapedial Artery
Arch 3: Carotid Artery
Arch 4: Left side becomes part of the arch btwn the LCC and LS/ Right side becomes R.Subclavian
Arch 5: Transient (disappears)
Arch 6: Pulmonary Arch
134
Q

Embryonic Development: what are the 3 main groups of vein during development and what do they become?

A
  • Vitelline Venous System: Hepatic Veins
  • Umbilical Venous System: Umbilical vein in term fetus
  • Cardinal Venous System: Large complex network of veins throughout the body
135
Q

Embryonic Development: what organs do not function until birth

A

Lungs (filled w/ fetal lung fluid which increases PVR)
Kidneys
GI Tract

136
Q

Embryonic Development: In what direction do the umbilical artery and vein carry blood

A

U. Artery= Away from fetus to the placenta (carries wastes and CO2)
U. Vein= To the fetus from the placenta (carries nutrients and oxygen)

137
Q

Embryonic Development: Is there mixing of maternal and fetal blood?

A

No. Waste/nutrient exchange occurs in intervillous spaces

138
Q

Embryonic Development: what is the concentration of hemoglobin and O2 affinity in fetal blood compared to mothers blood

A

hemoglobin is 50% higher

higher affinity for O2: carries 30% more oxygen

139
Q

Embryonic Development: when does the mother begin to transfer antibodies to the fetus? when does the fetus begin to make their own components of complements?

A

Mother transfers over antibodies (mainly IgG) at 14 wks

  • Fetus starts to make own during late first trimester
  • Newborns make own IgG but they wont reach adult levels until age 3
140
Q

Embryonic Development: in regards to fetal circulation, how does flow from the SVC and IVC differ

A

SVC: RA-RV-PA-Ductus Arteriosus-Descending Aorta
IVC: RA- through Foramen Ovale-LA-LV-Aorta

141
Q

Embryonic Development: what is the only fetal vessel to carry fully oxygenated blood

A

umbilical vein

142
Q

Embryonic Development: what are the 3 blood shunts that normally close after birth? what do the turn into?

A

Foramen Ovale= Fossa Ovalis
Ductus Arteriosus= Ligamentum Arteriosum
Ductus Venosus= Ligamentum Venosum (in liver)

143
Q

Embryonic Development: how long after birth does it take for the ductus arteriosus to become the ligamentum arteriosum?

A

closes after 1-2 days

-complete obliteration of the lumen takes 1-3 months

144
Q

what is the HR, resp. rate and MAP in newborns compared to adults

A

Newborns: Higher; HR 140 RR 40..Lower MAP 60

Adult HR 80 RR 15 MAP 90

145
Q

what is the difference btwn ionized and serum Ca++? what are the normal values?

A 
Ionized= not bound to proteins (1.1- 1.3 mmol/L)
Serum= bound to proteins (2.1- 2.6 mmol/L)
146
Q

in pediatrics, what blood gas values are particularly important

A

mixed venous

147
Q

define Atrioventricular Septal Defects (AVSD)

A

Incomplete fusion of the endocardial cushions which causes a deficiency or absence of the septal tissue above or below the A-V valves: Results in abnormal valve shape/function

148
Q

what is AVSD’s commonly associated with (4)

A

Downs Syndrome

TOF, DORV, AS

149
Q

Embryonic Development: during what stages (days) do most congenital diseases form

A

Days 27-37: Atrial and Ventricular septation

Day 29: Outflow tract septation

150
Q

whats the difference btwn Complete, Partial and Transitional AVSDs

A
  • Complete: all chambers mix
  • Partial: Ostium Primum ASD and cleft MV (AV node and Coronary Sinus are displaced)
  • Transitional: leaflets of common AV valve are stuck to the ventricular septum
151
Q

the 2 general ways to repair an AVSD are palliation or complete repair. describe all options for each

A
  • -Palliation: PA Band (decrease PBF, increase PVR)/ BTT or Central Shunt (increase PBF)
  • -Complete: Bi-Ventricular (Close ASD [pericardial patch] & VSD [dacron patch] then fix cleft MV)/ Univentricular (Done in stages: BTT Shunt, Glen, Fontan)
152
Q

what is the difference btwn the bi-directional glenn and hemi-fontan procedure

A

Glenn: SVC is attached to PA

Hemi-Fontan: PA is attached to RA and SVC is patched

153
Q

describe the fontan

A

conduit from IVC to PA with a fenestration (pop off valve) to prevent pulmonary over circulation
-these patients are exercise intolerant bc they cant change RV output

154
Q

when coming off bypass after a Fontan procedure- what will you need to do

A

you have to double the volume you began with- so you will probably have to add blood or crystalloid

155
Q

if an AVSD is not treated, what will happen to the patient

A

the defect will cause lung disease bc the patient will have a larger volume of blood which is handles by the right heart- the increase in vol will increase pressure in the lungs- pulmonary vessels thicken to compensate and the damage becomes irreversible

156
Q

what are the pump considerations for an AVSD Bi-Ventricular Repair (cannulas, disposables, CPG, ect.)

A 
Art Cannulation= Aortic
Ven Cannulation= Bicaval
LV Vent
XC
Antegrade CPG
157
Q

what are the pump considerations for an AVSD Bi-Directional Glenn Shunt or Fontan (cannulas, disposables, CPG, ect.)

A

Art Cannulation= Aortic
Ven Cannulation= Single
-may circ arrest

158
Q

an absent PV is a rare defect in which the valve is not formed or incomplete. what does this defect cause and what other defect is it associated with? is there right or left shunting

A

causes massive dilation of the pulmonary arteries

  • associated with a VSD
  • R to L shunt
159
Q

describe Pulmonary Atresia with an intact ventricular septum (physical structure). is there right or left shunting? what is PBF dependent on?

A
  • PV is small (but the PA is normal)
  • RV and TV are hypoplastic
  • has an ASD to decompress the RA
  • R to L shunting
  • PBF is dependent on PDA (baby needs PGE-1 after birth)
160
Q

describe Pulmonary Atresia with VSD (physical structure).

A
  • Extreme TOF (complete mixing-cynosis)
  • PAs are hypoplastic
  • Large VSD
161
Q

what does pulmonary stenosis cause? what type of shunting may be present

A

RV hypertrophy

-R to L shunt via ASD (cyanosis develops)

162
Q

what other defects is AS associated with? what are these patients at high risk for?

A

LV Hypertrophy, PDA, MS, Coarctation

-Cardiac Arrest

163
Q

what is the Konno procedure? what defect does it fix?

A

widen LVOT and replace aortic root

-treats AS (subvalvular)

164
Q

what other defects is AI associated with

A

LV dilation, decreased CO, CHF

165
Q

describe the Ross procedure

A

AV replacement- uses the patients own PV and then replaces the PV with a homograft
-No anticoagulation needed post-op

166
Q

describe Ebsteins Anomaly. how do you fix it?

A

“Atrialized RV”
Tricuspid Insufficiency causes RA enlargement
-Treat: repair TV and resect redundant RA wall

167
Q

describe Tricuspid Atresia. what type of shunting is present? what other defects must be present

A

Absent TV

  • R to L shunting (severe cyanosis)
  • ASD or PFO must be present to get blood to the left heart…. and a VSD or PDA must be present for pulmonary flow
168
Q

what does MV Insufficiency cause?

A

LV dilation and hypertrophy

169
Q

describe MV Prolapse? what is it associated with?

A

MV leaflets prolapse into LA during systole

-associated with MV Insufficiency

170
Q

what is the most common valvular defect

A

MV Stenosis

171
Q

what does MV Stenosis cause

A
  • LA dilation

- Increased LA, PV and RV systolic pressures (leads to pulmonary HTN, edema and right HF)

172
Q

what is a valvuloplasty

A

transcatheter balloon insertion into a valve- balloon fills widens/ stretches valve

173
Q

what is the Melody Valve

A

transcatherter PV replacement

174
Q

what is the Edwards Sapien Valve

A

transcatheter AV replacement (treats AS)

175
Q

what is the difference btwn Cor-Triatrium Sinistrum and Cor-Triatrium Dextrum

A 
Sinistrum= 2 Left atriums and 1 Right atrium
Dextrum= 2 Right atriums and 1 Left atrium
176
Q

what are the pump considerations for a Cor-Triatrium repair (cannulas ect)

A

Art cannula= Aortic
Ven cannula= Bicaval
–if the Pulmonary Veins are involved then you may have to circ arrest

177
Q

describe the BF path when a PDA is present

A

blood flows from the aorta back into the PA and re-enters the lungs (pulmonary over-circulation)…then when pressures begin to build up in the lungs- the shunt can reverse and cause cyanosis (shunt reversal is called Eisenmengers Syndrome)

178
Q

what is PDA shunt reversal called

A

Eisenmengers Syndrome

179
Q

what drug is given if they want the PDA to remain open after birth

A

Alprostadil (Prostaglandin E1)

180
Q

describe the Classic Blalock-Taussig Shunt and its purpose

A

Subclavian to PA

Increase Pulmonary BF

181
Q

describe the Modified Blalock-Taussig Shunt and its purpose

A

Gore-Tex Graft: Subclavian to Pa

Increase Pulmonary BF

182
Q

describe the Central Shunt and its purpose

A

Gore-Tex Graft: Ascending Aorta to Main PA

Increase Pulmonary BF

183
Q

describe the Waterston Shunt and its purpose

A

Ascending Aorta to Right PA

Increase Pulmonary BF

184
Q

describe the Potts Shunt and its purpose

A

Descending Aorta to Left PA

Increase Pulmonary BF

185
Q

describe the Brock Shunt and its purpose

A

Pulmonary Valvotomy

Increase Pulmonary BF

186
Q

what shunt is used to decreased pulmonary BF

A

PA Band

187
Q

what is the Rashkind procedure

A

Balloon septostomy- widens a PFO or ASD to improve mixing (L to R) and allow more oxygenated blood to enter circulation

188
Q

what shunt is used to decrease ventricular work

A

bi-directional glenn

189
Q

describe Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)- what does it lead to? how is it treated?

A

Left coronary artery originates from the PA

  • leads to severe coronary hypoperfusion, LV dysfunction
  • treated with coronary reimplantation or the Takeuchi Procedure (transpulmonary baffle btwn the PA and Aorta)
190
Q

what are the pump considerations for ALCAPA surgery

A
  • Art cannula= Aortic
  • Ven Cannula= Bicaval
  • LV Vent: inserted through the right superior PV and then both the PAs are snared to avoid runoff of coronary perfusion into the pulmonary circulation
  • CPG: Aortic Root (for the right coronary) and direct ostial (for the left coronary artery)
  • Terminate slowly until the high LA pressures normalize
191
Q

describe Vascular Rings/Double Aortic Arch. how is it treated?

A

Trachea and esophagus are encircles by vascular structures. The right arch has the right carotid and subclavian- the left arch has the left carotid and subclavian
-treated via left thoracotomy- OFF pump

192
Q

describe an Interrupted Aortic Arch. what are they usually associated with. describe each type.

A

Absence or discontinuation of a portion of the aortic arch

  • usually associated with a VSD
  • Type A: interrupted left arch- distal to left subclavian
  • Type B: interrupted left arch- distal to left carotid
  • Type C: interrupted left arch- proximal to left carotid
193
Q

what are the pump considerations for an Interrupted Aortic Arch

A

Art Cannula= 2 aortic cannulas wyed together
Ven Cannula= Single
CPG: Antegrade at root then possible ostial
Temp: DHCA during arch reconstruction

194
Q

describe Aortic Coarctation? how is it treated?

A

narrowing of the arch- usually distal to the left carotid

  • treated with balloon aortoplasty or patch augmentation
  • Off pump or left heart bypass
195
Q

describe Total Anomalous Pulmonary Venous Return (TAPVR). what other defect is required for survival

A

oxygenated blood returns from the lungs back to the RA- so systemic and pulmonary circulations are completely separate (severe cyanosis) -Supracrdiac placements of pulmonary veins is most common
-an ASD or PFO is required to allow the oxygenated blood on the right side to go to the left
TRUE EMERGENCY

196
Q

describe Obstructive Total Anomalous Pulmonary Venous Return

A

the pulmonary veins run into the abdomen and pass through the diaphragm which squeezes/narrows the veins- causing back up into the lungs and increased RA/RV pressures

197
Q

describe Partial Anomalous Pulmonary Return (PAPVR)

A

Oxygenated blood returns from the lungs to both the RA and LA

198
Q

how is a Total or Partial Anomalous Pulmonary Venous Return surgically corrected- what are the pump considerations

A

the pulmonary veins are returned to a common confluence behind the LA

  • Art Cannula: Aortic
  • Ven Cannula: TAPVR= Single/ PAPVR= Bicaval
  • DHCA or low flow hypothermia
  • may use ECMO for neonates w/ residual pulmonary HTN
  • Acidosis may develop
199
Q

describe a Tetralogy of Fallot

A

4 defects (3 congenital and 1 aquired)
VSD/ PS/ Overridding Aorta/ RV Hypertrophy
-R to L shunt
-causes cyanosis

200
Q

describe a Pentalogy of Fallot

A

a normal TOF (VSD/ PS/ Overridding Aorta/ RV Hypertrophy) with the addition of an ASD

201
Q

how does the body compensate to the low sats and decreased PBF that a TOF causes

A

increases hct (>50%)

202
Q

how is a TOF treated (2 options)

A
  • BT or Central Shunt

- Complete Repair: fix PS and VSD (Rastelli Procedure: RV-PA Conduit)

203
Q

what are the pump considerations for a TOF

A

Art Cannula: Aortic
Ven Cannula: Bicaval
CPG: Antegrade (have to give more frequently bc the heart will warm from the collaterals)
Temp: mild/moderate
-may need ECMO bc of RV dysfunction
-watch hct levels (may have to add crystalloid to dilute)

204
Q

describe a Double Outlet Right Ventricle (DORV)

A

the aorta and PA both originate from the RV- blood in the LV goes through a VSD to reach the aorta/PA
-pulmonary overcirculation occurs

205
Q

what are the 2 options to fix a double outlet right ventricle

A
  1. Anatomic: repair normal circulation w/ 2 ventricles (patch VSD and do a Rastelli [RV-PA Conduit])
  2. Univentricular: repair circulation w/ 1 ventricle (patch VSD and do a Fontan [single ventricle left is the LV])
206
Q

what are the pump considerations for a double outlet right ventricle

A

Art Cannula: Aortic
Ven Cannula: Bicaval (Single if doing single ventricle)
CPG: Antegrage (have to give more frequently bc the heart will warm from the collaterals)
Temp: mild/moderate
-may need ECMO from pulmonary over circulation
-watch hct levels (may have to add crystalloid to dilute)

207
Q

describe Hypoplastic Left Heart Syndrome

A

underdeveloped LV and Aorta
ASD
Huge PDA (bigger than the aorta)

208
Q

what is Qp/Qs? what is the normal value

A

Pulmonary Flow compared to Systemic Flow
Normal Value= 1
(over 1.5= pulmonary over circulation)

209
Q

what is the difference btwn an intra and extra cardiac Fontan

A

Intra: Conduit inside RA- follows a hemi-fontan
Extra: Conduit outside RA- follows a Bi-Directional Glen
–most common if the Glen and extra cardiac Fontan

210
Q

what are the pump considerations for a Norwood procedure

A

Art Cannula: PA
Ven Cannula: Single
CPG: Antegrade
Temp: DHCA

211
Q

what are the pump considerations for a bi-directional glen or hemi-Fontan or Fontan

A

Art Cannula: Aorta
Ven Cannula: Single
CPG: BDG=None/ HF= Antegrade/ F= w/ or w/o CPG
Temp: moderate

212
Q

how does pediatric myocardium differ from adults

A
  • uses glucose oxidation (adults use fatty acids)

- prone to stretch injurry

213
Q

when does neonate myocardium mature

A

3-12 months

214
Q

what are the estimated blood volumes per weight:

A

40 kg= 65 ml/kg

215
Q

what are the common circuit sizes:

A 
Neonate: 3/16 * 1/4
Infant: 1/4 * 1/4
Pediatric: 1/4 * 3/8
Small Adult: 3/8 * 3/8
Adult: 3/8 * 1/2
216
Q

what are the common weight based flows:

A 
0-3 kg= 200 ml/kg
3-10 kg= 150 ml/kg
10-15 kg= 125 ml/kg
15-30 kg= 100 ml/kg
>30 kg= 75 ml/kg
>55 kg= 65 ml/kg
217
Q

what are the stroke volumes per revolution (roller pump) for the different tubing sizes?

A 
3/16= 7 ml
1/4= 13 ml
3/8= 27 ml
1/2= 45 ml
(do not exceed 100 rpms per tubing size: 1/2= 4500rpms)
218
Q

what are the volume is a foot of tubing per tubing size

A 
3/16= 7 ml/ft
1/4= 9.65 ml/ft
3/8= 21.7 ml/ft
1/2= 38.6 ml/ft
219
Q

how do you calculate volume in tubing

A

Length * Pie * Radius^2

all in centimeters

220
Q

how much venous return is SVC vs IVC

A

SVC- 1/3 flow

IVC- 2/3 flow

221
Q

What is the max flow and prime volume for the Terumo Baby RX05, RX10 and RX15

A 
RX05= 1.5 LPM and 43 ml PV
RX10= 4.0 LPM and 135 ml PV
RX15= 5.0 LPM and 135 ml PV
222
Q

What is the max flow and prime volume for the Sorin Kids D100 and D101

A 
D100= 0.7 LPM and 31 ml PV
D101= 2.5 LPM and 87 ml PV
223
Q

why can neonates immature myocardium better withstand ischemia

A

bc immature myocardium uses anaerobic glycolysis

224
Q

what are 3 physiologic differences for infants/neonates you need to remember for CPB

A
  1. Prone to hypocalcemia
  2. Effects of hemodilution are enhanced
  3. They have a high O2 consumption rate= higher flows
225
Q

what are the glucose differences for ped and adult CPB

A

Ped: watch for low glucose levels (prone to hypoglycemia)
adult: watch for high glucose levels (prone to hyperglycemia)

226
Q

what are the inflammatory response differences for ped and adult CPB

A 
Ped= Exaggerated response 
Adult= Regular response
227
Q

what are the urine output differences for ped and adult CPB

A 
Ped= 1 ml/kg/HOUR
Adult= 0.5-1 ml/MIN
228
Q

how is intermittent low flow bypass performed

A

1-2 minutes of flow every 15-20 min

229
Q

Name 3 cerebral oximeters

A

INVOS
Nonin Equinox
Fore-Sight

230
Q

what is the most common ASD type

A

Ostium Secundum ASD

231
Q

describe the 4 types of ASDs

A
  1. Ostium Secundum: mid level- by coronary sinus
  2. PFO: regular patent foramen ovale
  3. Ostium Primum: above TV
  4. Sinus Venosus: can be inferior (above IVC) or superior (below SVC)
232
Q

what do the inferior and superior portions of the ventricular septum consist of

A 
Inferior= muscular
Superior= membranous
233
Q

describe the 4 types of VSDs

A
  1. Inlet: below TV
  2. Outlet (Supracristal): below PA
  3. Peri-Membranous: by AV node
  4. Muscular-Septum: apex
234
Q

what is the most common type of VSD

A

Membraneous VSD

235
Q

describe Transposition of the Great Arteries/Vessels. what has to be present for life?

A

the Aorta and PA are switched (creates 2 separate circulations)
-an ASD or VSD has to be present for the kid to live

236
Q

what is the difference btwn dextro and levo classifications of transposition of the Great Arteries

A 
Dextro= Aorta is anterior and to the right
Levo= Aorta is anterior and to the left
237
Q

what form of transposition of the great arteries is most common

A

dextra (D-TGA)

238
Q

the 2 options for complete surgical repair for transposition of the great arteries are Atrial Switches or Arterial Switches- each have 2 subtypes- describe them

A

Atrial Switch= Mustard [uses pericardium tissue] or Senning [uses atrial tissue] (reverse flow via intra-atrial baffle)
Arterial Switch= Jatene [for D-TGA] or Le Compte [for L-TGA] (Aorta and PA are switched back)

239
Q

describe Truncus Arteriosus. how is it treated?

A

a single blood vessel comes out of the RV and LV (instead of a separate PA and Aorta), has a VSD also
-treated: vessel becomes the aorta and a rastelli is used for the RV-PA conduit and VSD is patched

240
Q

what is the typical initial and maintenance heparin dose for ECMO protocol (units/kg). what should the ACT be kept at

A

Initial dose: 40-80 units/kg
Maintenance dose: 10-13 unites/kg/hr
ACT: 300 sec during cannulation then 160-180 maintenance

241
Q

what are the target ECMO flows (ml/kg/min) for:
Neonate:
Pediatric:
Adult:

A

Neonate: 100-150 ml/kg/min
Pediatric: 75-100 ml/kg/min
Adult: 50-90 ml/kg/min
(flow higher for V-A ECMO compared to V-V)

242
Q

name 1 pros and 2 cons of VA ecmo

A

PROS: complete heart/lung support and rest
CONS: increased LV afterload & possible cardiac stun (bc coronary’s receive lower oxygenated blood)

243
Q

name 2 pros and 2 cons of VV ecmo

A

PROS: lung support & decreased neurologic injury
CONS: decline in renal function after 48hrs & no direct circulatory supprot

244
Q

describe a congenital diaphragmatic hernia

A

the small intestine moves through the diaphragm and compresses the lung- after surgery, they are put on ecmo

245
Q

describe hyaline membrane disease

A

lack of surfactant (atelectasis)- can be treated with ecmo

246
Q

does VA or VV ecmo provide better coronary oxygenation

A

VV

247
Q

is VA or VV ecmo better for sepsis patients

A

VV

248
Q

describe VA ECMO cannulation

A

usually RA to Aorta

-used for pts post-CPB- usually switch to femoral cannulation once they can close the chest (to prevent infection)

249
Q

describe VA ECMO cannulation

A

femoral vein to femoral artery

-may cause limb/coronary/brain ischemia

250
Q

how does increasing or decreasing BF effect the amount of CO2 in the blood

A

decreasing BF allows for prolonged exposure to the oxygenators fibers, resulting in more CO2 being blown off= decreased CO2

251
Q

what are the 2 options to treat a low venous saturation

A
  1. Increase O2 delivery (increase FiO2, Increase BF, RBC Transfusion)
  2. Decrease Metabolismm (Hypothermia, Sedatives/Paralytics)
252
Q

what 3 things does the VA ECMO mixing cloud depend on

A

cannulation site
rate of ECMO BF
Cardiac contractility

253
Q

during VA ECMO, if the aortic valve is not opening (the heart is not ejecting)- what does that mean

A

it means that all arterial BF is being provided by ECMO (so the ECMO ABG is the Pts ABG)

254
Q

when femoraly cannulated for ECMO- the mixing cloud can be anywhere from the arterial cannula to the aortic valve. Where is the mixing cloud when there is little cardiac function and high ecmo flows? how does the cloud move once the heart increases function/ejection

A

the mixing cloud is closer to the heart and can position under the head vessels which can then perfuse the right and left sides of the body with different levels of oxygen.
-when the heart increases contractility- the cloud is pushed closer to the cannula- and it can again position itself under the head vessels

255
Q

how do you wean from VA ECMO

A

decrease flow (RPMs)

256
Q

how do you wean from VV ECMO

A

decrease sweep and FiO2

257
Q

When possible NIRS baselines should be recorded before induction. What is a normal NIRS value? During surgery, how should you maintain NIRS?

A

Normal= 60-80%

Maintain above 75-80% above baseline

258
Q

what is the Denault Algorithm

A

Used to trouble shoot cerebral saturation problems with NIRS

259
Q

besides cerebral oximetry during CPB, what other things can NIRS be used for

A

lower limb perfusion during fem-fem ECMO

260
Q

besides using the cell saver to chase the circuit after a case, what is another option? what is the benefit?

A

using a Hemobag via ultrafiltration

- gives back whole blood (RBCs, Platelets, Clotting Factors)

261
Q

what should the INR be kept at for VAD patients

A

target INR= 2-3

remeber that VAD pts are at risk for hemorrhagic or embolic stroke

262
Q

what is LVAD performance dependent on

A

right heart function

right HF is a significant cause of mortality

263
Q

describe preload/afterload characteristics for VAD pumps

A 
preload dependant (needs adequate volume)
afterload sensitive (minimize resistance [SVR])
264
Q

what are 7 contraindications for VAD Therapy

A
  1. Multi-organ failure w/ no expected recovery
  2. Severe obstructive/restrictive pulmonary disease
  3. Severe pulmonary HTN
  4. Elevated PT due to DIC or liver failure
  5. Dialysis dependent renal failure
  6. Sepsis or active infection
  7. Irreversible cerebral injury
265
Q

what VAD options do you have for bridge to recovery

A

RVAD, LVAD or BiVAD

  • Abiomed Impella
  • Tandem Heart
  • Thoratec CentriMag
  • Thoratec PVAD
266
Q

what VAD options do you have for bridge to transplant

A

LVAD, BiVAD or TAH

  • CardioWest TAH
  • Thoratec PVAD
  • Thoratec HeartMate II LVAD
  • HeartWare LVAD
267
Q

what VAD options do you have for destination therapy

A

LVAD ONLY!

  • Thoratec HeartMate II LVAD
  • HeartWare LVAD
268
Q

describe the Thoratec CentriMag:

  • Clinical Indication:
  • Length of Support:
  • Pump Features:
  • Clinical Considerations:
A
  • Clinical Indication: bridge to recovery (LVAD, RVAD, BiVAD)- pump choice for ECMO
  • Length of Support: Short-term (
269
Q

describe the Abiomed Impella:

  • Clinical Indications:
  • Length of Support:
  • Pump Features:
  • Clinical Considerations:
A
  • Clinical Indications: cardiogenic shock/infarct reduction

- Length of Support: Short-Term (

270
Q

describe the TandemHeart:

  • Insertion type:
  • Pump features:
  • Flow:
A
  • Insertion type: Percutaneous insertion with transseptal cannula
  • Pump features: Centrifugal pump, reduces workload of LV
  • Flow: up to 5 LPM
271
Q

describe the Thoratec HeartMate II LVAD

  • Implant site:
  • Length of Support:
  • Pump Features: Pulseless BF
A

-Implant site: Under the heart- connected to external controller via the driveline
-Length of Support: 7+ years- battery lasts 10-14 hrs
-Pump Features: Pulseless BF
(most common one at the Mayo)

272
Q

describe the HeartWare

  • Implant site:
  • Length of support:
  • Pump features:
A
  • LVAD only*
  • Implant site: LV wall in pericardal space- connected to external controller via driveline
  • Length of support: 7+ years- battery lasts 4-6 hrs
  • Pump features: Pulseless BF
273
Q

what types of VADs are pulsatile Devices

A

PVADs

TAHs

274
Q

Normal Values:

  • EF=
  • SVR=
  • PVR=
  • Coronary Artery Pressure
A
  • EF= 40-60%
  • SVR= 800-1200
  • PVR=
275
Q

Noraml Values: (Sys/Dia)

  • RA=
  • RV=
  • PA=
  • LA=
  • LV=
  • Aorta=
A
  • RA= 4/2
  • RV= 20/4
  • PA= 20/10
  • LA= 6/3
  • LV= 125/5
  • Aorta= 120/80
276
Q 
Normal Values: Arterial on pump:
pH:
pO2:
pCO2:
O2 Sat:
BE:
Bicarb:
A 
pH: 7.4
pO2: 250
pCO2: 40
O2 Sat: 100%
BE: +/- 2
Bicarb: 24
277
Q 
Normal Values: Venous on pump:
pH:
pO2:
pCO2:
O2 Sat:
BE:
Bicarb:
A 
pH: 7.4
pO2: 40
pCO2: 45
O2 Sat: 75%
BE: +/-2.5
Bicarb: 24
278
Q

Normal Values:

  • O2 delivery:
  • O2 consumption:
  • O2 consumption index:
A
  • O2 delivery: 1000 ml/min
  • O2 consumption: 225 ml/min
  • O2 consumption index: 140 ml/min/m2
279
Q

Normal Values:

  • Na=
  • K=
  • Ca=
  • Mg=
  • Cl=
  • Glucose=
  • BUN=
  • Creatine=
  • Creatinine=
A
  • Na= 135-145
  • K= 3.5-5.0
  • Ca= 1.1- 1.35
  • Mg= 1.3-2.1
  • Cl= 95-105
  • Glucose= 75-115
  • BUN= 10-20
  • Creatine= 0.2- 0.8
  • Creatinine=
280
Q

Normal Values:

  • RBCs=
  • WBCs=
  • Hgb=
  • Hct=
  • Platelets=
A
  • RBCs= 5,000,000 per uL
  • WBCs= 5,000 per uL
  • Hgb= 15 g/dL
  • Hct= 40-50%
  • Platelets= 200,000 per uL
281
Q

Normal Values=

  • PT=
  • PTT=
  • APTT=
  • ACT=
  • FSP=
A
  • PT= 12 sec
  • PTT= 40 sec
  • APTT= 20 sec
  • ACT= 90-120 sec
  • FSP=

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