Test 1 content

Question 1

When using 4 to 1 cardioplegia set how much blood/cardioplegia solution is delivered when giving a 1000 cc dose of cardioplegia?

Answer 1

800cc blood and 200cc cardioplegia solution

Question 2

The difference between traditional buckburg type (4:1) cardioplegia and Del Nido cardioplegia is:

Answer 2

Del nido is given at a ratio of 1:4

Question 3

What effect does severe aortic insufficiency have on cardioplegia delivery?

Answer 3

Decreases aortic root pressure between the aortic cross clamp and the aortic valve

Question 4

What pressure should be monitored when giving retrograde cardioplegia?

Answer 4

Coronary sinus

Question 5

What effect does biocompatible coating have on tubing?

Answer 5

Internal components of the circuit “wet” more easily

Question 6

The purpose of a “safety time out” in the OR is to:

Answer 6

Introduce OR team and discuss procedure

Question 7

What factor is most important when setting up a sterile pump circuit?

Answer 7

Room logistics

Question 8

When setting up a sterile pump circuit you should:

Answer 8

Use an organized routine, avoid letting the tube touch the ground and wear a mask

Question 9

Coronary artery bypass graft procedures are performed on patients with:

Answer 9

Ischemic heart disease

Question 10

One of the main differences between a roller pump and centrifugal pump when being used as an arterial pump is:

Answer 10

A centrifugal pump is non-occlusive

Question 11

To de-air a heart is to:

Answer 11

flood with Co2

Question 12

Del nido is a _______ tinged solution and is ___ part blood to ____ part crystaloid. Given about ___ every hour

Answer 12

• Blood tinged
• 1 part blood to 4 parts crystalloid
• Used about once an hour

Question 13

_____Reserved for patients with end-stage heart disease not amenable to optimal medical therapy or other surgical procedures

Answer 13

Cardiac transplantation

Question 14

End-stage cardiac failure is characterized by:

Answer 14

• Irreversible, severe ventricular dysfunction
• Low cardiac output
• Poor end-organ perfusion
• Activation of compensatory neurohumoral pathways

Question 15

In the early stages of heart failure, stroke volume is maintained by:

Answer 15

• Increase in LV end diastolic volume

* Increase in myocardial fiber length

Question 16

Active ingredients of del nido cardioplegia?

Answer 16

Plasma lyte A, mannitol 20%, sodium bicarb 8.4%, potassium chloride 2 mEq/ml, Magnesium sulfate 4.06 mEq/ml, lidocaine
(In other solutions High K+, low K+ can be used)

Question 17

What is myocardial preservation?

Answer 17

The need to protect the myocardium from intraoperative and postoperative damage.
Addresses injury that can be caused by ischemia.
Allows surgeon to work in on a still heart.
Facilitates certain intra-cardiac procedures.
Extends the amount of time the surgeon has for certain procedures that require disrupting blood flow to the myocardium.

Question 18

What is the end result of prolonged ischemia?

Answer 18

Tissue death!

Question 19

3 Methods of myocardial preservation

Answer 19

Temperature
Chemical arrest
Continuous perfusion

Question 20

In terms of myocardial energy consumption what uses the least or most energy?

Answer 20

• Beating Non working heart-LEAST

* Fibrillating heart - MOST

Question 21

Solutions for chemical arrest:

Answer 21

Hyperkalemic solution
del Nido solution
Custodial solution
St. Thomas solution
Plegisol solution

Question 22

Antegrade Cardioplegia delivery

Answer 22

Should monitor line pressure and/or aortic root pressure.
Aortic valve must be competent
Does not address distal ischemic heart disease (CAD)
Relatively easy to administer

Question 23

Hypothermia has what 4 benefits?

Answer 23

• Reduces metabolic activity
• Increases margin of safety
• Facilitates lower systemic flows
• Causes constriction

Question 24

Potassium concentrations between _____ mEq/L for complete asystole arrest.
Redosed every ______ minutes during periods of ischemia.

Answer 24

• 18-24 mEq/L

* every 10-30 mins

Question 25

Potassium concentrations between ______ mEq/L for maintenance.

Answer 25

4-6 mEq/L

Question 26

Order of anastomoses

Answer 26

1. left atrium 2. right atrium 3. pulmonary artery 4. aorta

Question 27

Irreversible, severe ventricular dysfunction leads to low ______

Answer 27

CO-Cardiac output

Question 28

Increase in mycardial fiber length means heart gets ________

Answer 28

distended (becomes baggy)

Question 29

______ can develop b/c kidneys are not working properly

Answer 29

Edema

Question 30

______ is a common anti inflammatory, typical one they use. A lot of bad things can happen to you on this. Used for ______

Answer 30

* Prednisone | * Immunosuppression

Question 31

You don't want to treat a rejection so well cause it could hurt the _______

Answer 31

Kidneys

Question 32

Bicaval cannulation used cause you don't want blood Q going back where?

Answer 32

Right atrium. Look like they cannulate the IVC and SVC to completely bypass RA.

Question 33

_________ gives you option to perfuse the head vessels

Answer 33

Axillary Cannulation

Question 34

_____ is used on a descending aneurysm

Answer 34

Thoracotomy

Question 35

We need full bypass for which aneurysm?

Answer 35

``` Decending aneurysm (might leave heart beating in this case) ```

Question 36

Includes dissections that involve the proximal aorta, arch, and descending aorta

Answer 36

DeBakey type I

Question 37

Only involves the ascending aorta

Answer 37

DeBakey type II

Question 38

Dissections that originate in the descending thoracic and thoracoabdominal aorta regardless of retrograde involvement

Answer 38

DeBakey type III

Question 39

Involvement of the descending thoracic aorta

Answer 39

DeBakey type IIIa

Question 40

Involvement of the thoracoabdominal aorta

Answer 40

DeBakey type IIIb

Question 41

All dissections that involve the ascending aorta regardless of where the primary tear occurs is a _________

Answer 41

Type A dissection | stanford classification

Question 42

Stanford type A includes ___________

Answer 42

DeBakey types I and II

Question 43

Stanford type B Includes______

Answer 43

DeBakey types IIIa & IIIb

Question 44

Thoracoabdominal Aneurysms

Answer 44

* Crawford Classification * Has permitted a standardized reporting of aneurysm extent allowing for appropriate stratification of risks and treatment modalities

Question 45

Crawford classification can be in how many types?

Answer 45

I, II, III, IV

Question 46

Thoracoabdominal Aneurysm Extent I involves:

Answer 46

Involves most of the descending thoracic aorta from the left subclavian down to the vessels in the abdomen Usually the renal vessels are not involved

Question 47

Thoracoabdominal Aneurysms Extent II involves:

Answer 47

Begin at the left subclavian and extend to the infrarenal abdominal aorta even as far as the inguinal area

Question 48

Thoracoabdominal Aneurysms extent III involve:

Answer 48

Extent III | Involve the distal half of the descending thoracic aorta and substantial segments of the abdominal aorta

Question 49

Thoracoabdominal Aneurysms extent IV involve:

Answer 49

Extent IV | Involve the upper abdominal aorta and all or none of the infrarenal aorta

Question 50

Aortic Aneurysms risk factors:

Answer 50

Smoking Hypertension Atherosclerosis Genetic disorders: Marfans Syndrome, Ehlers-Danlos syndrome

Question 51

Aneurysm etiology include:

Answer 51

Loss of elastic fibers and smooth muscle cells leading to cystic medial necrosis The weakening of the aortic wall and loss of elasticity leads to an increase in the diameter of the aorta and dilation of the vessel Dilation results in increased wall tension relative to aortic pressure

Question 52

Aneurysm Preemptive surgery is recommended when:

Answer 52

Ascending aneurysm is at 5.5 cm | Descending aneurysm is at 6.5 cm

Question 53

_________procedure is to save the valve if you can

Answer 53

Valve sparing procedure Other procedures include: * Simple tube graft * Ross procedure

Question 54

Aortic arch aneurysms usually require ______

Answer 54

DHCA May employ antegrade or retrograde cerebral perfusion)

Question 55

Bentall Procedure (5 steps)

Answer 55

Right axillary artery and right atrial cannulation Placed on CPB and cooled to 16-18 degrees Aorta is cross clamped and opened Heart is arrested with cardioplegia infusion into the coronary ostia Aortic valve is removed (((Composite prosthesis is sutured to the aortic annulus Coronary buttons are attached to the graft The patient is completely cooled, the pump is stopped and the aortic cross clamped is removed The distal ascending aorta and the proximal arch is excisedThe distal anastomosis is completed Pump flow is initiated slowly to deair the graft Rewarming is begun)))

Question 56

Ascending and arch replacement (5 steps)

Answer 56

Right axillary and right atrial cannulation Cooling to 16-18 degrees Aortic cross clamp and opening of the aorta Cardioplegia via coronary ostia Aorta is reconstructed with Teflon impregnated Dacron graft (Hemashield®) (((After adequate cooling, the pump flow is stopped (circulatory arrest) the cross clamp is removed, and the arch is opened A graft is anastomosed to the head vessels A cross clamp is applied to the graft Antegrade cerebral perfusion is begunAn “elephant trunk” graft is placed into the descending aorta The proximal end of the elephant trunk graft is then anastomosed to the ascending graft The graft from the head vessels in then anastomosed to the graft to complete the procedure)))