Cardiac Surgery

Question 1

What is Ischemic heart disease?

Answer 1

Coronary flow getting limited by coronary artery stenosis

Question 2

How do we diagnose site and severity of the ischemic heart disease?

Answer 2

Via a coronary angiograph

Question 3

For ischemic heart, we give medical treatments but also PCI, what is PCI?

Answer 3

The balloon dilation of the stenosed segment, we then place a stent inside it

Question 4

Ischemic sometimes calls for surgery, what is it called?

Answer 4

CABG, coronary artery bypass graft surgery

Question 5

So explain CABG steps 1 and 2

Answer 5

Median sternotomy, then hooking up the patient to an ECC

Question 6

Explain the heart (pun intended) of the CABG procedure

Answer 6

We use the Saphenous vein from the leg and anastomose it to the coronary artery to act as a bypass

Question 7

What other grafts can we use for CABG?

Answer 7

Internal mammary artery

Question 8

Complications of CABG?

Answer 8

Perioperative infarction, low cardiac output, bleeding, arrhythmias

Question 9

What is the commonest cause of rheumatic fever?

Answer 9

Mitral Valve Stenosis

Question 10

How do we assess mitral valve?

Answer 10

Doppler Echo

Question 11

What gradient, if exceeded, indicates severe mitral stenosis?

Answer 11

10mmHg

Question 12

What are the 3 treatments for mitral valve?

Answer 12

Prosthesis replacement, PBMV, and Open mitral commissurotomy

Question 13

First line treatment option for mitral valve?

Answer 13

PBMV, percutaneous balloon mitral valvuloplasty

Question 14

What is Open Mitral Commissurotomy?

Answer 14

Using ECC to split the commissures and fused chorda tendinae and papillary muscles

Question 15

After valve replacement, what is the patient placed on (oral medication)

Answer 15

Anticoagulant for 3 months

Question 16

Deciding on what mitral surgery to do, is dependent on the Wilkins score, what is it?

Answer 16

If the score is less than 8, then we do PBMV, if from 8-11, then we do an open commissurotomy, if more than 11, valve replacement

Question 17

What is the commonest cause of mitral regurgitation in Egypt?

Answer 17

Rheumatic fever

Question 18

What is the general treatment for mitral regurgitation?

Answer 18

Valve repair or replacement

Question 19

What are the indications of Aortic surgery?

Answer 19

Valve orfice area is less than 1cm, and the PSG is greater than 70mmHg (systolic pressure gradient)

Question 20

What is the treatment for aortic stenosis?

Answer 20

Valve replacement using a cardiopulmonary bypass

Question 21

What causes tricuspid regurgitation?

Answer 21

Result of hypertension from mitral valve disease

Question 22

What is the most common cyanotic heart defect?

Answer 22

Tetralogy of Fallot

Question 23

What is the first treatment for tetralogy?

Answer 23

Palliative shunt (modified blalock-Taussig ) a closed cardiac procedure done before total correction

Question 24

What are the goals of Total Correction for tetralogy of Fallot?

Answer 24

Closing the VSD Via a patch (Gore-Tex), and correcting the PS

Question 25

How do we treat Tricuspid Atresia?

Answer 25

Glenn’s shunt, followed by univentricular repair (Fontain’s operation)

Question 26

What is the commonest cardiac tumor?

Answer 26

Myxoma

Question 27

How do we diagnose and treat myxomas?

Answer 27

Echo, and surgical excision

Question 28

Constructive pericarditis is?

Answer 28

The calcification, thickness, and restriction of the pericardial space

Question 29

What does CXR show in Constrictive Pericarditis?

Answer 29

Calcification of the pericardium, albeit CT and Echo are better in assessing the pericardial thickness

Question 30

What is the surgical treatment for Constrictive Pericarditis?

Answer 30

Complete resection of the pericardium through a median sternotomy

Question 31

What is Pericardial Effusion?

Answer 31

Fluid accumulation in the pericardial cavity

Question 32

What are the clinical findings in Pericardial Effusion?

Answer 32

Pulsus Paradoxus and Beck’s Triad (distended neck veins, muffled heart, hypotension)

Question 33

What diagnosis Pericardial Effusion?

Answer 33

Echo

Question 34

How do we treat Pericardial effusion if there is an Acute Tamponade?

Answer 34

Pericardiocentesis, under local anesthesia we drain the pericardial fluid with a needle.

Question 35

What is the surgical treatment to Pericardial Effusion?

Answer 35

Essentially creating a window to drain all the blood, via resecting part of the pericardium open

Question 36

What is Aortic Dissection?

Answer 36

An injury to the innermost layer of the aorta

Question 37

How do we diagnose aortic dissection?

Answer 37

The 5 P’s. Pain, Pallor, paralysis, Parasthesia. Essentially severe pain in the chest both front and back.

Question 38

Aortic Dissection investigations?

Answer 38

CT to show the tear and what type it is, (A or B),

Question 39

What is the treatment of Type A aortic dissection?

Answer 39

Tube graft replacement of the ascending aorta through a sternotomy

Question 40

Treatment for Type B aortic dissection?

Answer 40

Can be stabilized medically, via sedation, analgesia, and lowering blood pressure/pulse. Essentially calming the person

Question 41

How do we treat Aortic Aneurysms?

Answer 41

Replacement with a Dacron Tube Graft

Question 42

Should the aortic aneurysm be at the distal arch, what is the surgery?

Answer 42

Tube graft through left thoracotomy

Question 43

Should the aortic aneurysm be at the root and producing aortic regurgitation, what is the surgery?

Answer 43

Bentall’s Operation.