Cardiothoracic Flashcards
Indications for CABG?
> 70% left main stem stenosis
symptomatic patients with >70% proximal LAD stenosis
symptomatic patients with >70% in all three vessels
concomitant valvular disease which requires replacement
vessel disease in a diabetic
CABG procedure?
midline sternotomy
conduit (saphenous vein, left internal mammary artery, radial artery) is anastomosed
Complications of CABG?
death
stroke
re-sternotomy for bleeding or tamponade
chest infection
atrial fibrillation
wound infection
renal failure
Mechanical vs Bioprosthetic valves?
mechanical:
>20yrs
require warfarin
noisy
bioprosthetic:
10yrs
no need for warfarin
silent
Causes of aortic stenosis?
‘wear and tear’ calcific degeneration
bicuspid valve
rheumatic disease
Presentation of aortic stenosis?
SAD
syncope
angina
dyspnoea
ejection systolic crescendo-decrescendo murmur loudest in aortic area radiating to carotids
heaving apex beat
Investigations in aortic stenosis?
ECG (left ventricular hypertrophy)
TTE (degree of stenosis)
Indications for valve replacement in aortic stenosis?
mean gradient across valve >40 mmHg
symptomatic
Surgical options in aortic stenosis?
open surgical aortic valve replacement via thoracotomy
transcatheter aortic valve implantation (TAVI)
Causes of mitral regurgitation?
mitral valve prolapse due to ischaemia (papillary muscle rupture)
rheumatic disease
infective endocarditis
CT disorders
Presentation of mitral regurgitation?
acute MR -> CCF
chronic MR -> exertional dyspnoea
orthopnoea
displaced apex beat
AFib
pansystolic murmur loudest at apex and radiating to axilla
+/- third heart sound
Investigations for mitral regurgitation?
TTE
TOE
Indications for surgery in mitral regurgitation?
acute MR
severe chronic MR
Surgical approach to mitral regurgitation?
open valve replacement
endovascular Mitra clip if open surgery contraindicated
Causes of mitral stenosis?
rheumatic heart disease most common