Cardiac Adult 3.0 Flashcards
Bicuspid Aortic Valve
- Subtypes
*
Type 1: Fusion of left and right coronary cusps
Type 2: Fusion of Right and Non Coronary
Type 3: Fusion of the Left and Non-coronary
Bicuspid Aortic Valve
Pathology:
Most common configuration?
How does it relate to pathology?
Bicuspid Aortic Valve
Most common configuration:
Left-Right Cusp Fusion (Type 1):
2 commissures oriented anteroposterior, giving left and right cusps.
- more likely to develop stenosis in adulthood
- associated with root dilation,
Bicuspid Aortic Valve
Pathology:
Second most common configuration ?
What does this tell about the natural history?
Bicuspid Aortic Valve
Second most common:
Type two: Right-Non fusion.
more likely to have accompanying ascending aorta and arch dilation.
Type 2 valves will lead to complications at a younger age.
Bicuspid Aortic Valve
What is the rarest configuration?
How rare is it?
Bicuspid Aortic Valve
The rarest (< 1% of patients): fusion of the left and non-coronary cusps.
Bicuspid Aortic Valve
Indications for surgery:
- Valve Indications*
- identical to other patients with aortic stenosis or aortic regurgitation.
- Aortic Indications*
with a valve-related indication for replacement:
- the aorta should be replaced if its diameter is greater than 4.5 cm in bicuspid patients.
no valve indication for surgery
a maximal diameter of the aorta greater than 5 cm
change in diameter of >0.5 cm in 1 year.
Risk of PPM following SAVR and TAVR
- but the overall frequency is 3-6%.
- following TAVI up to 25% of patients require new permanent pacing.
what % of SAVR patients have some extent of postoperative bradyarrhythmia
- Transient postoperative AV block of some magnitude occurs in nearly 45% of patients after AVR.
Risk factors for PPM following SAVR
- stentless aortic prostheses
- implanting smaller sized valves (<21 mm)
- AVR in children and women (possibly also because of smaller size)
- Reoperations
- combined procedures (mitral valve or CABG plus aortic valve surgery)
- Aortic regurgitation is associated with an increase in the risk of PPM
Patient Prosthesis Mismatch
formula and degrees
The effective orifice area is usually obtained from echocardiographic measurements, and the EOIA = (orifice area / patient BSA).
It is mild if >0.85 cm2/m2,
moderate at 0.65-0.85 cm2/m2,
severe if <0.65 cm2/m2.
Time course for revascularization following a STEMI
A patient with an acute STEMI and cardiogenic shock gains survival benefit within 6 hours of onset of symptoms from emergency revascularization either with primary percutaneous coronary interventions (PCI) or emergency coronary artery bypass graft (CABG).
the procedure of alpha-stat and pH-stat?
Alpha Stat - hypothermic blood loses CO2, but continue protein buffer
The desired effect -preserve cerebral autoregulation and intracellular enzyme activity
pH-Stat - adds CO2 to the circuit to maintain a pH at decreased temperatures
the idea behind alpha-stat
Alpha Stat - hypothermic blood loses CO2, but continue protein buffer
The desired effect -preserve cerebral autoregulation and intracellular enzyme activity
the idea behind pH-stat
pH-Stat - adds CO2 to the circuit to maintain a pH at decreased temperatures
populations in which pH stat and alpha stat are optimal
- the pH-stat strategy in children and neonates,
- alpha-stat may reduce cerebral edema in adults
“if you know the alphabet alpha is better”
