Miscellani

Question 1

Where Classical Coarctation usually located? When do you intervene for a coarctation?

Answer 1

Commonly at insertion of ductus arteriosus - distal of left subclavian
intervene when 20mmHg across gradient

Question 2

What are the risk factors for statin induced rhabdomyolysis?

Answer 2

Low BMI, older age, female sex, hypothyroidism, hypertension, polypharmacy, and alcohol

Question 3

What is the most common cardiac Valvular defect?

Answer 3

bicuspid AV then VSD

Question 4

When should VSDs be closed?

Answer 4

Signs of significant Shunt Qp:Qs >1.5 +/- LV dilatation
endocarditis
Eisenmenger’s - CONTRAINDICATIOn

Question 5

What is Eisenmenger Syndrome

Answer 5

initial L-> R Shunt (ie VSD)
Then build up of pulmonary vascular resistance and reverses shunt
R -> L

Question 6

What is Severe AS?

Answer 6

Valve area < 1
Mean Gradient >40
Peak Jet velocity > 4

Question 7

When to do a SAVR for AS?

Answer 7

Severe AS + Sx
Severe AS + LVEF < 50%
Severe AS + going under GA for other heart surgery stuff

Question 8

When would you consider using TAVI for AS?

Answer 8

• not funded in Aus really atm
• life expectancy > 1 year
• high operative risk not good for SAVR

Question 9

What is Bicuspid AV associated with?

Answer 9

AR, premature AS
Aortopathy - ascending aorta dilatation
if ascending aorta > 5cm - surgery pls

Question 10

When to do AV repair for AR?

Answer 10

Symptomatic patients
doing some other heart surgery at the same time
Asymptomatic + LVEF < 50%

Question 11

What is Low Flow Low Gradient AS and how to figure out if its True AS?

Answer 11

valve area < 1, EF < 50%, Gradient does meet criteria
–> Do dobutamine stress Echo if Mean Gradient > 40 –> TRUE AS
if not its pseudo AS from heart failure

Question 12

What is severe mitral regurgitation?

Answer 12

Vena contracta >0.7
Regurgitant Volune > 60
LV dilatation + LA Dilatation

Question 13

When do to surgery for MR?

Answer 13

Severe MR + Symptoms + LVEF > 30

Severe MR + Asymptomatic LVEF < 60