home made practice exam Flashcards
Define zone for stenting
0 ascending and brachiocephalic a. 1 common carotid a. Region 2 left subclavian region 3 isthmus region 4 descending
Cut off when aorta rupture or dissect
Ascending 6 cm ( lifetime risk jump to 30%)
Descending 7 cm (lifetime risk jump to 40%)
Yearly risk of composite of death,rupture or dissection
Overall if more than 6 cm 14%
If between 5 and cm 6,5%
Growth rate of aneurysm
Ascending 0,1 cm per year
Descending 0,3 cm per year
Time for safe DHCA depending on Temp
15 degree 25 min
20 degree 20 min
25 degree 15 min
Way to monitor brain in arch surgery
NIRS Jugular sat Transcranial Doppler EEG Evoked potential
Ante grade perfusion: rate and pressure
10 cc/kg/min
Pressure between 50-60
As low as 40 acceptable
More 70-80 if carotid lesion
Axillary cannulation
Advantages and disadvantages
Advantages Antegrade flow Less malperfusion risk Less arch manipulation (stroke) Easy to convert to cerebral perfusion
Disadvantages
Vessel trauma
Plexus trauma
What about Femoral cannulation
Advantages
Fast
Easy
Disadvantages
Malperfusion
Retrograde perfusion (stroke)
Alpha vs ph stat
Alpha
Maintain cerebral autoregulation
Better enzymatic function
Ph
Cerebral vasodilatation ( easier cooling but more stroke risk)
Left shift of oxyHb curve ( better oxygen availability)
What about retrograde perfusion
Good for cooling and flushing debris
Better than DHCA alone
Not so good for nutritional support
Risk of cerebral edema
Maximal pressure 25 mmHg and flow between 300-500cc per min
Surgical adhesives pro and con
Pro Hemostatic Reinforce tissue Anastomotic support Reduce transfusion
Con Toxicity (aldehyde part) Need a dry field Preparation time Infection risk Stricture ( so avoid in peds) Embolisation
3 characteristics of CRT patient
FC > II
EF < 35
Conduction delay 150ms
Succes rate of CRT
66%
Class 1 indication PPM
Sinus node dysfunction
Symptomatic Brady
Chronotropic incompetence
Symptomatic Brady because of required med
AV dysfunction
3 and advanced AV block with
Symptoms
Required med therapy causing bradycardia
Pause 3 sec
Rate less than 40
After KT ablation
After cardiac surg
LV dysfct
After MI
Alterning LBBB and RBBB with 2 degree
Symptomatic 2 or 3 degree
Indication class 1 defibrillator
Cardiac arrest with VF or VT after excluding reversible cause
Structural heart disease with VT
Syncope unknown origins, VT induced in lab
40 days after MI and EF < 35 and symptoms
40 days after MI and EF < 30 no symptoms
40 days after MI and EF < 40 with inducible VT
Non ischemic CMP with EF < 40 and symptoms
But if surgically revascularized may wait 3 months before taking the decision
Most common complication of device (PPM, defibrillator
Lead displacement 2%
Cryo pro and con
Pro
Spare collagen structure
Con
Longer
Bad on beating heart
Other sources are radiofrequency, HIFU, microwave and laser
Indications to do a MAZE
Symptomatic AF undergoing an other cardiac procedure
Asymptomatic AF undergoing an other cardiac surgery with no extra risk to do it
Stand alone AF if meds or KT failed when symptomatic
Controversial : contraindications to ACO
Prevention of AF CCS guidelines
Start beta blocker preoperatively
Preoperatively or postoperative amio
Magnesium
Atrial pacing
Cardiac neoplasia Name 4 more frequent Primary benign adult Primary benign peds Primary malignant Secondary
Benign adult Myxoma Lipoma Fibroelastoma Hemangioma
Benign peds
Rhabdomyoma
Teratoma
Fibroma
Hemangioma
Primary malignant Angiosarcoma Rhabdomyosarcoma Mesothelioma Fibrosarcoma
Secondary Leukaemia Melanoma Lung Breast
Aortic dissection classification
Stanford
A involving ascending
B not involving ascending
DeBakey I ascending and descending II ascending IIIa descending until diaphragm IIIb descending and below diaphragm
Independent from the tear*****
