CV Surgery Lecture Powerpoint

Question 1

Preop eval for cardiovascular disease (7)

Answer 1

• cardiac catheterization (inject dye to detect degree of stenosis)
• TEE (transesophageal echo to look at heart valves and ejection fraction)
• PFT (lung complications and severity)
• carotid doppler (detect stenosis)
• CXR (baseline, aortic calcification, COPD presence)
• lab tests (CBC, coags, complete metabolic panel, urinalysis, A1c, thyroid studies)
• CT scan

Question 2

Indications for surgery in CAD (3)

Answer 2

• left main >50% presence
• length of stenosis
• vessels involved (2+)

Question 3

Conduit selection of coronary artery bypass grafting

Answer 3

• internal mammary artery (most often left)
• saphenous vein (cannot be varicose, have to put in the right way so valves aren’t blocking!)
• radial artery (allen test it first!)

Question 4

Cardiopulmonary bypass definition, what are some cons of it (3)?

Answer 4

A machine that removes venous blood, takes over function of heart, oxygenates blood, taking over function of lungs, and then returns arterial blood, while providing cardioplegia (high K+ solution that stops the heart from beating), “bloodless” procedure making it easy space to work with

• microemboli
• increased post op neurological event
• temporary cognitive delay (pump brain)

Question 5

Causes of aortic stenosis (3)

Answer 5

• age
• bicuspid aortic valve (anatomic)
• rheumatic fever

Question 6

Mechanical valve vs bioprostetic valve

Answer 6

Mechanical lasts forever and thus is good for younger patients but bad for noncompliant as requires anticoag with coumadin and and coumadin only**, vs tissue from animals and lasts 10-15 years so better for elderly and those who are not compliant, does not require any anticoag

Question 7

TAVR Replacement

Answer 7

Currently approved for moderate to high risk patients with aortic stenosis involving temporarily pacemaking heart to stop it and then placement of a new valve in the place of the old one and expansion via balloon catheterization, risk of leak or heart block in future as these artificial valves can expand over time

Question 8

Aortic surgery for ascending aortic aneurysm indications (3)

Answer 8

• measures >5cm
• dissection
• rapidly enlarging or co-occurring pathology

Question 9

Post op care in cardiac surgery patients (4)

Answer 9

• Return to ICU for first 24 hours when most unstable for hemodynamic monitoring
• insertion of swan ganz catheter for monitoring
• intubation temporarily and wean off soon as tolerated
• chest tube and monitoring for hemothorax or tamponade

Question 10

Intraaortic balloon pump

Answer 10

Indicated in a patient in cardiogenic shock pre or post op that inflates during diastole and contracts during systole to help improve ejection fraction, coronary perfusion, decreases afterload

Question 11

ECMO

Answer 11

Extracorporeal membrane oxygenation that is indicated for failure of cardiac and or pulmonary system, VA is used to pull out venous blood, oxygenate it, and return it, VV pulls it out the blood of the venous system, oxygenates it, and returns it to the venous system as the heart is pumping well on its own