Adult Cardiac Flashcards
OPCAB
Similar rates of periop stroke, MI, renal failure, cost
Lower blood transfusion rate
Cutoff for doing concominant aortic surgery (root or ascending) in bicuspid aortic valve
4.5cm
Blood cardioplegia
Blood mixed with cardioplegia increases O2 delivery to hyopthermic cadiac myocytes. O2 dissociation curve shifted left to there is less release to tissues so HIGH O2 content is necessary for tissue extraction
Anomalous right coronary artery
Rare (more common japanese)
courses between Aorta and PA
Risk of arrythmia, MI, sudden death
Treat with unroofing
Conduit patency rates
Mammary - 90% 10 year
BIMA skeletonized does not increase rate of wound infection in trials
SVG - 50% 15 year
Radial - 92.5% 7 year (patency decline if lesion less than 70%)
GE - more susceptible to steal and higher closure than other radial
Low EF, borderline AS severity on echo
Low flow/low gradient AS
Dobutamine stress echo to elucidate
Paget schroeder- TOS
Compression of SC vein by clavicle/first rib/scalene muscle
First AC and catheter lysis
Then early first rib resection
No role for stenting and high rate of failure for long term AC without surgery
Must debrideme subclavius tendon at angle between clavicle and rib
Restrictive cardiomyopathy vs constructive pericarditis
Both caused by prior radiation. Present with diastolic HF
Constrictive - equalization of LV and rV end diastolic pressure. Very sensitive to respiratory variation
Restrictive - LV>RV EDP. Less respiratory variation
CTEPH diagnosis
V/Q scan needed to dx. Pulmonary angiogram and CT with contrast may miss distal disease and can’t differentiate acute/chronic
PA pressure> 25 with wedge <15 in presence of multiple organized clot
Indication for ICD
EF<35% and NYHA 2/3, 90 days post revascularization. Benefits should be seen by 90 days
EF<30% with any NYHA class if patient expected to live a year
LVAD outcome
50% 5 year mortality
OHT survival
75% 5 year
50% 10 year
Screening for aortopathy
First degree relatives of patient with dissection/aneurysm should get ECHO screening. No CTA unless echo suggests
Screen for Marfans if >1 family has aortic disease or if presence of associated signs
LA mass
Usually myxoma treated with simple excision
Sarcoma less likely but also in LA. Complete resection is key and may need to remove whole septum and patch reconstruct
Adjuvant chemo/rad probably improves survival but limited benefit
Cold agglutination
Autoantibodies against RBCs cause clumping and micro/small vessel clots
Immediately avoid hypothermia and cold pledgia. Switch to normothermia and warm cardioplegia. Maybe. Flush retrograde w warm pledge
.8-4%
