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Surgery 1 > Cardiac Surgery > Flashcards

Cardiac Surgery Flashcards

1
Q

What is Ischemic heart disease?

A

Coronary flow getting limited by coronary artery stenosis

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2
Q

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

A

Via a coronary angiograph

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3
Q

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

A

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

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4
Q

Ischemic sometimes calls for surgery, what is it called?

A

CABG, coronary artery bypass graft surgery

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5
Q

So explain CABG steps 1 and 2

A

Median sternotomy, then hooking up the patient to an ECC

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6
Q

Explain the heart (pun intended) of the CABG procedure

A

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

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7
Q

What other grafts can we use for CABG?

A

Internal mammary artery

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8
Q

Complications of CABG?

A

Perioperative infarction, low cardiac output, bleeding, arrhythmias

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9
Q

What is the commonest cause of rheumatic fever?

A

Mitral Valve Stenosis

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10
Q

How do we assess mitral valve?

A

Doppler Echo

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11
Q

What gradient, if exceeded, indicates severe mitral stenosis?

A

10mmHg

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12
Q

What are the 3 treatments for mitral valve?

A

Prosthesis replacement, PBMV, and Open mitral commissurotomy

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13
Q

First line treatment option for mitral valve?

A

PBMV, percutaneous balloon mitral valvuloplasty

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14
Q

What is Open Mitral Commissurotomy?

A

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

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15
Q

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

A

Anticoagulant for 3 months

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16
Q

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

A

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

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17
Q

What is the commonest cause of mitral regurgitation in Egypt?

A

Rheumatic fever

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18
Q

What is the general treatment for mitral regurgitation?

A

Valve repair or replacement

19
Q

What are the indications of Aortic surgery?

A

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

20
Q

What is the treatment for aortic stenosis?

A

Valve replacement using a cardiopulmonary bypass

21
Q

What causes tricuspid regurgitation?

A

Result of hypertension from mitral valve disease

22
Q

What is the most common cyanotic heart defect?

A

Tetralogy of Fallot

23
Q

What is the first treatment for tetralogy?

A

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

24
Q

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

A

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

25
Q

How do we treat Tricuspid Atresia?

A

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

26
Q

What is the commonest cardiac tumor?

A

Myxoma

27
Q

How do we diagnose and treat myxomas?

A

Echo, and surgical excision

28
Q

Constructive pericarditis is?

A

The calcification, thickness, and restriction of the pericardial space

29
Q

What does CXR show in Constrictive Pericarditis?

A

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

30
Q

What is the surgical treatment for Constrictive Pericarditis?

A

Complete resection of the pericardium through a median sternotomy

31
Q

What is Pericardial Effusion?

A

Fluid accumulation in the pericardial cavity

32
Q

What are the clinical findings in Pericardial Effusion?

A

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

33
Q

What diagnosis Pericardial Effusion?

A

Echo

34
Q

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

A

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

35
Q

What is the surgical treatment to Pericardial Effusion?

A

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

36
Q

What is Aortic Dissection?

A

An injury to the innermost layer of the aorta

37
Q

How do we diagnose aortic dissection?

A

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

38
Q

Aortic Dissection investigations?

A

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

39
Q

What is the treatment of Type A aortic dissection?

A

Tube graft replacement of the ascending aorta through a sternotomy

40
Q

Treatment for Type B aortic dissection?

A

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

41
Q

How do we treat Aortic Aneurysms?

A

Replacement with a Dacron Tube Graft

42
Q

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

A

Tube graft through left thoracotomy

43
Q

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

A

Bentall’s Operation.

Surgery 1 (28 decks)

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