IHD and valvular heart disease surgery

Question 1

what is a commissure of a heart valve?

Answer 1

the places where the cusps of the valves meet

Question 2

what are the conditions that cause cardiac ischaemia?

Answer 2

atherosclerosis
embolism
coronary thrombosis
aortic dissection
arteritides
congenital defects

Question 3

what is aortic dissection?

Answer 3

the intima and media of the aorta are ripped apart and blood enters the space

Question 4

what are the manifestations of ischaemic heart diseases?

Answer 4

angina
MI
arrythmias
chronic heart failure
sudden death

Question 5

what are the 2 dangerous patterns of coronary artery disease (which arteries are blocked)?

Answer 5

left main stem stenosis

3 vessel coronary artery disease

Question 6

what are the indications for CABG?

Answer 6

• symptomatic (any CAD pattern)

- prognostic (left main stem stenosis, s vessel coronary artery disease)

Question 7

what are requirements for patients to be able to undergo CABG?

Answer 7

adequate lung function
adequate mental function
adequate hepatic function
ascending aorta OK
distal coronary targets OK
left ventricular ejection fraction > 20 %

Question 8

what are the potential conduits used for CABG?

Answer 8

• reversed saphenous vein
• internal mammary arteries
• radial arteries

Question 9

what are the post-op problems in cardiac surgery?

Answer 9

cardiac tamponade
death
stroke

Question 10

what are the primary features of cardiac tamponade (following cardiac surgery)?

Answer 10

raised CVP
raised heart rate
low BP

Question 11

what are the secondary features of cardiac tamponade following cardiac surgery?

Answer 11

oliguria
increased oxygen requirementss
metabolic acidosis

Question 12

which coronary arteries are clocked in 3 vessel CAD?

Answer 12

LAD, RCA, LCX

Question 13

what is cardiac tamponade?

Answer 13

build up of fluid or blood in the pericardial space

Question 14

what can cardiac tamponade lead to if it becomes too severe?

Answer 14

cardiac arrest

Question 15

what are the valves most commonly operated on in adults?

Answer 15

aortic and mitral valves

Question 16

which valves of the heart are operated on in children?

Answer 16

all four valves

Question 17

what does the aortic root consist of?

Answer 17

• sinuses of valsalva (aortic sinuses)
• aortic valve
• annulus of aorta

Question 18

what can cause severe mitral regurgitation, where one of the cusps of the valve is inverted?

Answer 18

papillary muscle infarction

snapping of chordae tendinae

Question 19

what are the general causes of valvular heart disease in adults?

Answer 19

degenerative
congenital
infective
inflammatory
LV or RV dilatation
trauma
neoplastic 
paraneoplastic

Question 20

what are the 3 most common valve problems in Aberdeen?

Answer 20

• senile tricuspid aortic stenosis
• bicuspid aortic stenosis
• degenerative mitral regurgitation

Question 21

what is the test result used to diagnose recent rheumatic fever?

Answer 21

anti-streptolysin O (ASO)elevated

Question 22

what is the treatment for rheumatic fever?

Answer 22

aspirin and bed rest

Question 23

what are the symptoms of rheumatic fever?

Answer 23

arthritis
erythema marginatum
sydenham’s chorea

Question 24

which organism gives rise to subacute bacterial endocarditis?

Answer 24

strep. viridans

Question 25

which organism gives rise to acute bacterial endocarditis?

Answer 25

staph. aureus

Question 26

is endocarditis causes staph. aureas or strep. viridans more likely to be cured?

Answer 26

strep. viridans

Question 27

is there a greater chance of curing native valve endocarditis or prosthetic vave endocarditis?

Answer 27

native (90% chance compared to 50%)

Question 28

what are the indications for surgery in endocarditis?

Answer 28

severe valvular regurgitation
large vegetations
persistent pyrexia
progressive renal failure

Question 29

what is given after surgery to treat infective endocarditis?

Answer 29

antibiotics IV for 6 weeks

Question 30

what is the typical presentation for aortic stenosis?

Answer 30

• heart failure-like symptoms
• angina
• syncopal episodes
• or asymptomatic incidental finding
• systolic crescendo-decrescendo murmur

Question 31

what is the difference between aortic sclerosis and aortic stenosis?

Answer 31

aortic sclerosis is a less severe form of aortic stenosis.

in aortic stenosis there is loss of S2 but not in sclerosis

Question 32

what is the recommended treatment for severe aortic stenosis?

Answer 32

aortic valve replacement

Question 33

what is the typical presentation of aortic regurgitation?

Answer 33

• heart failure
• angina
• asymptomatic incidental finding

Question 34

what is the recommended treatment for aortic regurgitation?

Answer 34

aortic valve replacement, especially with LV dilatation

Question 35

when is surgery carried out for mitral regurgitation?

Answer 35

if on ECHO there is mitral valve area <1.5cm2

Question 36

what is the severe mitral regurgitation associated with/

Answer 36

LV and LA dilatation
onset of atrial fibrillation
pulmonary hypertension

Question 37

what is the treatment for severe mitral regurgitation?

Answer 37

mitral valve regurgitation

Question 38

what is the function of a cardiopulmonary bypass machine?

Answer 38

takes over the function of the heart and lung during heart surgery. (requires anticoagulation and induces hypothermia)

Question 39

what is a complication of open heart surgery?

Answer 39

air embolism

Question 40

what are the pros and cons of a biological valve?

Answer 40

no warfarin required but valve wears out after 15 years

Question 41

what are the pros and cons of a mechanical valve?

Answer 41

warfarin required for life. Valve lasts for >40 years

Question 42

what other surgical procedure apart from MVR is available to perform on the mitral valve?

Answer 42

mitral valve repair