max prediction for 2013 Flashcards
Severe aortic stenosis
Risk of mortality over the next year 1% Likelihood of developing symptoms in the next year 33% at 2 yr, 14% at 1 yr In aortic stenosis, what is the rate of decrease in valve area per year 0,1 cm2 7 mmHg (mean) 0,3 m/s
What is classification of Ebsteins
A: Little S-P leaflet displacement, Ant leaflet N, small atrialized chamber, RV N
B: Moderate S-P leaflet displacement, Ant leaflet N but chord aN, large atrialized chamber with reduced contractility, reduce size RV
C: Severe S-P displacement, restricted Ant leaflet, large atrialized chamber with low contractility, small and hypocontractile RV
D: Sac, no ant leaflet mobility, infundibular RV
Secondary tricuspid regurg
List 3 pathophysiologic mechanisms and an example for each
Annular dilatation (dilatated CMP) PHT (left lesion) Leaflet restriction (ischemia)
What are indications for endocarditis prophalaxis
Prosthetic valve or material for repair
Previous infectious endocarditis
Cyanotic unrepaired or palliated
Repair congenital anomaly 6 months postop
Repair with residual defect close to prosthetic material
Transplanted patient with valvulopathy
What is outcome of FREEDOM
Primary endpoint is composite of death all cause, MI and stroke
26,6% in PCI and 18,7% in CABG
List 3 negative of hco3 in CPR
Metabolic alkalosis
Intracellular acidosis
Large osmotic load
PCI in SYNTAX 5Y (increase, decrease or same) vs CABG
MACCE : inc Mortality : same Stroke : same MI : inc Repeat revasc : inc Cardiac mortality : inc MACCE LM : same in SYNTAX <33, inc SYNTAX >33 MACCE 3VD : same in SYNTAX <22, inc SYNTAX >22
Mechanism and histology of micro re-entry in a fib
Mechanism: shortened atrial refractory period, atrial tissue heterogeneity, electrical remodeling leads to micro reentry.
histology : atrial fibrosis ,decreased muscle mass, inflammation
Class I indication of CABG to improve survival
LM
3VD with or without prox LAD
2VD with prox LAD
Survivor of sudden death with presumed ischemia mediated VT
Ischemic MR: recent literature states certain subgroups benefits with reverse LV remodeling.
List 4 preoperative pedictors that suggest improved remodeling after CABG + IMR repair
LVEDD < 65
LVESD < 51
Systolic sphericity index below 0.72
Wall motion score index score below 1.59
5 predictors for developing symptoms or adverse outcomes in AS
Advance age CAD risk factors Calcium Peak jet velocity Progression Excessive LV hypertrophy Symptoms on exercise testing Increased natriuretic peptides
Spinal cord protection in thoracoabdominal
Partial or complete bypass avoidance of hypotension/maintenance of MAP avoidance of hyperglycemia partial hypothermia Reanastomosis of intercostals T7-T12 CSF drain
5 predictors of recurrent MR after ischemic MR repair
LVEDD >65 Posterior leaflet angle >45 Anterior leaflet angle >25 Tenting area >2,5 cm2 Coaptation distance >10mm End systolic interpapillary muscle distance >20mm Systolic shericity index >7
5 year freedom from death, symptoms and surgery in asymptomatic severe MR
70%
Sano shunt vs. modified BT shunt in Norwood operation
When blood flow occurred in coronaries and pulmonary arteries in both shunt.
Sano: coronaries in diastole and PA in systole
BT shunt: coronaries in diastole and PA in both
What are predictors of early SVG
Age <40
Hyperparathyroidism
Renal insufficiency
What are predictors of RVAD placement after LVAD
Preop vasopressors Preop ventilation support Increased bilirubin Increased creatinine Increased BUN Decreased RV stroke work index Increased CVP/Wedge ratio Increased CVP
Patient with dilated cardiomyopathy (EF<20%). Has been on “state of the art” meds. Now patient has NYHA class 3-4 failure. List 4 “state of the art” meds patient was on. List 4 non-medical treatment options for this patient.
Beta blocker, ACEI, spironolactone, digoxin or lasix???
CRT, LVAD, transplant, ICD??
Patient with LVEF 60%, with calcified aortic valve, AVA of 0.8 and gradient of 20mmHg. Compared to patient of AVA 0.8 and gradient of 40mmHg
List 2 ways these patients differ demographically
older age
female gender
concomitant presence of systemic arterial hypertension
2 ways they differ hemodynamically
Reduced LV compliance
Reduced stroke volume
A patient with low gradient AS will do ____ better/worse/equivalent with medical therapy. _____Better/worse/equivalent with surgery
What is drug, half life, and time to wait before surgery
Prasugrel: Thienopyridines, P2Y12 ADP inhibitor, 4hr, 7d
Clopidogrel: Thienopyridines, P2Y12 ADP inhibitor, 8hr, 5d
Ticagrelor: Cyclopentyltriazolopyrimidine, P2Y12 ADP inhibitor, 12hr, 5d
Abciximab: Gp IIb/IIIa inhibitor, 30min, 12hr
Tirofiban: Gp IIb/IIIa inhibitor, 2.2hr, 2-4hr
Dabigatran: Direct thrombin inhibitor, 12hr, normal renal fct 2d, abnormal renal fct 4d
