Cardiothoracic Surgery Flashcards
Vascular Rings
Pressure on tracheobronchial tree and pressure on esophagus.
Stridor and episodes of respiratory distress with crowing on respiration.
Barium swallow for esophagus. Bronchoscopy shows segmental tracheal compression and rules out diffuse trancheomalacia.
Surgery will divide the smaller of the two aortic arches.
Morphologic cardiac anomalies. Dx with what?
Echocardiogram.
Left to Right Shunts
Presence of murmur, overloading of pulmonary circulation,long term damage to pulmonary vasculature.
Atrial Septal Defect
Minor, low pressure, low volume shunt. Patients typically grow into late infancy before it is recognized.
Systolic murmur and fixed second heart split.
Ventricular Septal Defects
High in the intramembranous septum.
Failure to thrive, loud pansystolic murmur best heard at left sternal border. Increased pulmonary murmur.
Patent Ductus Arteriosus
Bounding peripheral pulses and continuous “machinery-like” heart murmur.
ECG is diagnostic. Closure can also be achieved with indomethacin.
Tetrology of Fallot
5 to 6 year old with cyanosis is tetralogy.
Spells of cyanosis relieved by squatting.
Echocardiogram and surgical repair is done.
Transposition of Vessels
Severe trouble early on. Kids kept alive by atrial or ventricular septal defect, or patent ductus.
Aortic Stenosis
Harsh midsystolic heart murmur best heard at right second intercostal space and along left sternal border.
Surgical valvular replacement is indicated if gradient is more than 50mmHg or at first indication of congestive heart failure, angina, or syncope.
Chronic Aortic Insufficiency
Wide pulse pressure, blowing high-pitched, diastolic heart murmur best heard at the second intercostal space and along lower sternal border.
Valvular replacement at first evidence on echocardiogram of beginning left ventricular dilatation.
Acute Aortic Insufficiency
Endocarditis is seen inyoung drug addicts who suddenly develop congestive heart failure.
Emergency valve replacement and long-term antibiotics are needed.
Patients with prosthetic valve
Antibiotic prophylaxis for subacute bacterial endocarditis.
Mitral Stenosis
Caused by rheumatic fever many years before presentation. Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, cough, and hemoptysis.
As sx becomemore disabling, mitral valve repair becomes necessary with surgical commisurotomy or balloon valvuloplasty.
Mitral Regurgitation
Valvular prolapse. Exertional dyspnea, orthopnea, and atrial fibrillation.
Apical, high-pitched, holosystolic heart murmur that radiates to axilla and back.
Annuloplasty > prosthetic valvuloplasty.
Post-Op of Heart Surgery Patients
Requires that cardiac output be optimized. If
