Cardiac Surgery Flashcards
What is Ischemic heart disease?
Coronary flow getting limited by coronary artery stenosis
How do we diagnose site and severity of the ischemic heart disease?
Via a coronary angiograph
For ischemic heart, we give medical treatments but also PCI, what is PCI?
The balloon dilation of the stenosed segment, we then place a stent inside it
Ischemic sometimes calls for surgery, what is it called?
CABG, coronary artery bypass graft surgery
So explain CABG steps 1 and 2
Median sternotomy, then hooking up the patient to an ECC
Explain the heart (pun intended) of the CABG procedure
We use the Saphenous vein from the leg and anastomose it to the coronary artery to act as a bypass
What other grafts can we use for CABG?
Internal mammary artery
Complications of CABG?
Perioperative infarction, low cardiac output, bleeding, arrhythmias
What is the commonest cause of rheumatic fever?
Mitral Valve Stenosis
How do we assess mitral valve?
Doppler Echo
What gradient, if exceeded, indicates severe mitral stenosis?
10mmHg
What are the 3 treatments for mitral valve?
Prosthesis replacement, PBMV, and Open mitral commissurotomy
First line treatment option for mitral valve?
PBMV, percutaneous balloon mitral valvuloplasty
What is Open Mitral Commissurotomy?
Using ECC to split the commissures and fused chorda tendinae and papillary muscles
After valve replacement, what is the patient placed on (oral medication)
Anticoagulant for 3 months
Deciding on what mitral surgery to do, is dependent on the Wilkins score, what is it?
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
What is the commonest cause of mitral regurgitation in Egypt?
Rheumatic fever
What is the general treatment for mitral regurgitation?
Valve repair or replacement
What are the indications of Aortic surgery?
Valve orfice area is less than 1cm, and the PSG is greater than 70mmHg (systolic pressure gradient)
What is the treatment for aortic stenosis?
Valve replacement using a cardiopulmonary bypass
What causes tricuspid regurgitation?
Result of hypertension from mitral valve disease
What is the most common cyanotic heart defect?
Tetralogy of Fallot
What is the first treatment for tetralogy?
Palliative shunt (modified blalock-Taussig ) a closed cardiac procedure done before total correction
What are the goals of Total Correction for tetralogy of Fallot?
Closing the VSD Via a patch (Gore-Tex), and correcting the PS
How do we treat Tricuspid Atresia?
Glenn’s shunt, followed by univentricular repair (Fontain’s operation)
What is the commonest cardiac tumor?
Myxoma
How do we diagnose and treat myxomas?
Echo, and surgical excision
Constructive pericarditis is?
The calcification, thickness, and restriction of the pericardial space
What does CXR show in Constrictive Pericarditis?
Calcification of the pericardium, albeit CT and Echo are better in assessing the pericardial thickness
What is the surgical treatment for Constrictive Pericarditis?
Complete resection of the pericardium through a median sternotomy
What is Pericardial Effusion?
Fluid accumulation in the pericardial cavity
What are the clinical findings in Pericardial Effusion?
Pulsus Paradoxus and Beck’s Triad (distended neck veins, muffled heart, hypotension)
What diagnosis Pericardial Effusion?
Echo
How do we treat Pericardial effusion if there is an Acute Tamponade?
Pericardiocentesis, under local anesthesia we drain the pericardial fluid with a needle.
What is the surgical treatment to Pericardial Effusion?
Essentially creating a window to drain all the blood, via resecting part of the pericardium open
What is Aortic Dissection?
An injury to the innermost layer of the aorta
How do we diagnose aortic dissection?
The 5 P’s. Pain, Pallor, paralysis, Parasthesia. Essentially severe pain in the chest both front and back.
Aortic Dissection investigations?
CT to show the tear and what type it is, (A or B),
What is the treatment of Type A aortic dissection?
Tube graft replacement of the ascending aorta through a sternotomy
Treatment for Type B aortic dissection?
Can be stabilized medically, via sedation, analgesia, and lowering blood pressure/pulse. Essentially calming the person
How do we treat Aortic Aneurysms?
Replacement with a Dacron Tube Graft
Should the aortic aneurysm be at the distal arch, what is the surgery?
Tube graft through left thoracotomy
Should the aortic aneurysm be at the root and producing aortic regurgitation, what is the surgery?
Bentall’s Operation.
