Cardiovascular disease and cardiac surgery

Question 1

What are the indications of CABG?

Answer 1

1. Left main disease, left main equivalent disease (proximal LAD and proximal circumflex), three-vessel disease
2. Acute MI + ongoing angina after infarction or unstable hemodynamic status
3. Ventricular arrhythmias + STEMI + failed PCI or anatomically not a PCI candidate

Question 2

When is PCI acceptable treatment option?

Answer 2

When its single-vessel or two-vessel disease

Question 3

What four grafts are used in descending frequency (depending on how good they are)? and why is LIMA conduit of choice?

Answer 3

LIMA, RIMA, Radial artery and saphenous vein

• LIMA are the conduit of choice because of superior patency rates compared with saphenous vein grafts (95% vs 60% at 10 years)

Question 4

In descending frequency, what are the four common complications of myocardial infarction?

Answer 4

Mitral regurgitation, left ventricular aneurysm, ventricular free wall rupture and VSD

Question 5

What are the indications of surgery in aortic stenosis?

Answer 5

• Symptomatic disease (Angina, syncope or HF)
• Cross-sectional area less than 1cm2
• Mean transvalvular pressure gradient more than 40 mm Hg

Question 6

What are the indications of surgery in aortic regurgitation?

Answer 6

• Symptomatic patient

- Ventricular dilation on echocardiography

Question 7

What are the indications of surgery in mitral stenosis?

Answer 7

• Acute or chronic symptoms of pulmonary venous hypertension
• NYHA class 3-4 symptoms
• Mitral valve area less than 1.5 cm2

Question 8

What are the indications of surgery in mitral regurgitation?

Answer 8

• Symptomatic disease
• Rapair is greater than 90% likely
• New atrial fibrillation
• Pulmonary artery pressure greater than 50 mm Hg at rest

Question 9

What are the indications of surgery in infective endocarditis?

Answer 9

• New onset heart failure or heart block
• Continued sepsis despite optimal medication management
• Valve dehiscence
• Fungal infection