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Flashcards in Test 2 Deck (63):
1

_________ is useful during OPCAB despite cardiac displacement

TEE

2

Heart valve surgery continues to involve

Complex hemodynamic management

TEE assessment

3

___________ requires use of 3D TEE

Mitral Valve Repair

4

Valuable resource in management of cardiopulmonary instability in noncardiac patients

TEE

5

Benefits of TEE during CAB

- Monitor ischemia
- Hemodynamic performance
- presence of ventricular air
- cannula placement

6

Management of patients with aortic stenosis

- Slow HR

- Higher perfusion pressure

- Monitor hemodynamic performance

7

Management of anesthesia in paitents with aortic insufficiency (regurgitation)

- faster HR

- optimal filling volume

- minimize regurgitant flow

8

Management of patients with mitral insufficiency

- faster HR

- optimal filling volume

- minimize regurgitant flow

9

Management of patients with mitral stenosis

- slower HR

- optimal filling volumes

- maintain RV function

- manage pulmonary HTN

10

TEE utilization in pt with aortic valve disease

- measure aortic valve area/gradient

- aorta and annular dimensions

- assess for coexisting disease

11

Utilization of TEE in patients with mitral valve disease

- measure mitral valve area/gradients

- mitral valve anatomy

- quality of repair

- pulmonary HTN

- biventricular function

12

Management of patient with aortic stenosis presenting for TAVR

- heart rate manipulation
- hemodynamic maintenance
- assess valve position
- assess paravalvular leaks

13

Qualitative TEE findings include

Volume status
Pericardial effusion
Contractility/bi-V function
Simple congenital cardiac defects

14

Quantitative TEE findings

PAP
CO
Valve function and area
Aorta dimension

15

Mitral stenosis is characterized by

Decreased SV

Decreased BP

Restricted diastolic inflow

16

Mitral stenosis pressure volume loops characteristically have

Decreased filling

Lower ventricular volumes

17

Mitral stenosis patients typically have

Pulmonary HTN and tricuspid regurg

18

Mitral stenosis patients typically have symptoms at rest when valve area

< 1.5cm

19

Pathological features of mitral stenosis include

LA enlargement

Decreased LV filling

Heart rate dependent CO

Sinus rhythm dependent BP

20

Moderate-severe mitral stenosis is associated with

- orifice area <1.5cm

-pressure half time >150ms

-pressure gradient across the valve >5mmHg

21

Mitral regurgitation pressure volume loops characteristically have

Higher ventricular volumes and lack isovolumetric contraction component

22

Hemodynamic goals for mitral stenosis include

Slow-normal HR

Increased SVR

Maintenance of normal PVR

23

Moderate-severe mitral stenosis is often associated with

RV failure

24

Pathological features of mitral regurgitation include

LA enlargement

Eccentric LV hypertrophy
- accommodate increased LV volume and decreased forward SV

25

Moderate/severe mitral regurgitation is associated with a regurgitant jet/vena contracta __________ and regurgitant jet that occupies at least

>3-6mm

2/3 LA by TEE

26

Hemodynamic goal in pt with mitral regurgitation

Normal-fast HR

Low-normal SVR

Preservation of intravascular volume/contractility

27

Post-bypass management of mitral valve surgery patients typically employs

Inotrope

Lower BP

Faster HR

28

Mitraclip is now being used for

Inoperable patients

Employs Alfieri stitch and TEE

29

Mitra regurgitation limits

Net forward flow

30

Principle compensatory mechanisms for mitral regurgitation

Fluid retention

Eccentric hypertrophy

31

Mitral stenosis results in

LA hypertrophy

Fixed SV

32

Mitral valve stenosis results in PCWP

Always overestimating LVEDP

33

During induction/maintenance of mitral stenosis

Avoid hypercapnia/hypoxia. (Increases PVR and causes RV failure)

34

Acute treatment of pulmonary HTN and RV failure

Hyperventilation

High FiO2 (prevent HPV)

Nitric Oxide

NTG

Isuprel, dobutamine, epi, Miri one, NE

RVAD

IPABP

IABP

35

RV dysfunction is extremely sensitive to

Afterload of PA

Optimal ventilation is key

36

Induction and maintenance with mitral regurgitation

Faster, fuller, vasodilates

37

Pressor for mitral regurgitation

NE

Avoid neo

38

Benefits of TEE during CAB

Monitor ischemia

Monitor hemodynamic performance

ID presence of ventricular air

Cannula placement

39

Management of patients with aortic stenosis

Slower HR

Higher perfusion pressures

Monitor hemodynamic performance

40

Management of anesthesia in patients with aortic insufficiency

Faster HR

Optimize filling volume

Minimize regurgitant flow

Faster Fuller Forward

41

Management of patients with mitral insufficiency

Faster HR

Optimal filling volume

Minimize regurgitant flow

faster fuller forward

42

Management of patients with mitral stenosis involves

Slower HR

Optimal filling volumes

Maintenance of RV function

Management pulmonary HTN

43

TEE is used in pt with aortic valve disease to

Measure AV area/gradient

Aorta and annular dimensions

Assess for coexisting disease

44

TEE is utilized in patients with mitral valve disease to

Measure MV valve area/gradient

MV anatomy

Quality of repair

Pulmonary HTN

Biventricular function

45

Management of patients with aortic stenosis presenting for TAVR

HR manipulation

Maintenance of hemodynamics

Assess valve position

Assess for paravalvular leaks

46

Qualitative TEE findings

Volume status

Pericardial effusion

Contractility/Bi ventricular function

Simple congenital cardiac defects

47

Quantitative TEE findings

PAP

CO

Valve function/area

Aorta dimensions

48

How body compensates fro heart valve disease

SNS activation

Increasing intravascular volume

Modified chamber dimensions

49

Aortic stenosis pressure volume loops characteristically have

Higher intraventricular pressure-volume relationships

50

Aortic regurgitation pressure volume loops characteristically have

Higher ventricular volumes

Lack isovolumic relaxation component

51

Pathological features of aortic stenosis

Concentric ventricular hypertrophy

Pressure overloading/high LV tension

Increased MVO2

52

Severe/critical AS is associated with

AV area

Aorta/LV gradient

Peak aortic jet velocity

AV valve area <1cm

Aorta/LV gradient >40mmHg

Peak aortic jet velocity >4m/s

53

Symptomatic aortic stenosis and/or NYHA III-IV should receive what for major surgery

Arterial line

PAC/TEE

54

Hemodynamic goals in paitents with aortic stenosis include

Slow-normal heart rate

Normal SVR

Preservation of LV contractility

55

Anesthetic considerations prior to CPB include

Assess aorta for plaque

Heparinization (300-400units/kg)

ACT >400seconds

56

Best TEE window for assessing ventricular function and filling is

Transgastric view

57

Hemodynamic goals post CPB in patients with AS include

Maintain optimal LV filling

SR

Judicious use of inotrope

58

Mediastinal bleeding >_____ necessitates re-exploration in OR

300ml/hr

59

Cerebral protection during circulatory arrest may include

Profound hypothermia

Ice to head

Propofol infusion

Monitor cerebral oxygen saturation

60

Anesthesia considerations for patients with hypertrophic cardiomyopathy (HOCM) include

Maintain adequate intravascular volume

Increased SVR

Myocardial depression

Deep anesthesia

61

Pathological features of aortic regurgitation include

Eccentric LV hypertrophy

Volume overload

Decreased net SV

62

Severe/moderate aortic regurgitation is associated with

Vena contracta

Pressure half time

Regurgitant jet

Vena contracta >6mm

Pressure half time <200

Regurgitant jet >65% width of LV outflow tract

63

Anesthesia management of patients with aortic regurgitation includes

Maintenance of faster HR

Lower SVR

Preservation of contractility