overview of cardiac sx Flashcards
What are the 4 different strategies for cardiac surgery
1) Beating Heart Surgery
2) Inflow occlusion/brief circulatory arrest
3) Cardiopulmonary bypass
4) Hybrid cardiac surgery
What is the intent of PDA ligation surgery
Curative
What is the intent of pulmonary banding for VSD
Palliative
What is the intent of modified Blalock-Taussig Shunt
Palliative for Tetralogy of Fallot
modified Blalock-Taussig Shunt is for
Palliative for Tetralogy of Fallot
What is the intent of Epicardial Pacemaker
Curative for AV block and SA node dysfunction
Types of beating heart surgeries
1) PDA ligation (curative)
2) Pulmonary banding (palliative for VSD)
3) Modified Blalock Taussig Shunt (Palliative for Tetralogy of Fallot)
4) Epicardial Pacemaker (Curative for AV block and SA node dysfunction)
T/F: PDA ligation is curative
True
What is a downside to PDA ligation
1) Expensive
2) Not everyone can undergo minimally invasive catheter procedure due to size and availability
What heart condition if the dilatable pulmonary artery banding for
VSD
What occurs with a VSD
Increase blood floe to the lungs, LA and LV
causes LA/LV dilation and a volume overload
the increased pulmonary vascular resistance and pressure overload leads to RV hypertrophy
once R pressure gets high enough it shunts R to L and cyanosis occurs (Eisenmenger’s Syndrome)
Eisenmenger’s Syndrome
When a L to R shunt reverses and becomes R to L due to increased RV pressure overload from increased pulmonary artery overload
How does dilatable pulmonary artery banding work to correct VSDs
Band across the pulmonary artery so that the pressure of the right side increases to be equal to the left side so there isnt as much movement between them
this is palliative
dilatable pulmonary artery banding is indicated as palliative therapy got
VSD L to R shunt
What are the 4 features of Tetralogy of Fallot
1) Pulmonic stenosis
2) VSD
3) Overriding aorta
4) RV hypertrophy
Non-oxygenated blood goes through shunt and out to circulation
a cyanotic congenital heart disease
modified Blalock-Taussig Shunt attaches the _____ to the _____
Left Subclavian artery to Pulmonary artery
Why might you give a patient an epicardial pacemaker
For cases of AV node block or Sick Sinus Syndrome - altenrative to endocardial pacemaker
1) Complications related to endocardial pacemaker - infection, hypercoagulability, immunosuppressed
2) Cats or small breed dogs
3) Other cardiothoracic or abdominal surgery
What is an approach to modified Blalock-Taussig Shunt
1) Transdiaphragmatic approach - hard for deep chested dog
2) Medial thoracotomy
procedures that provide brief period of circulatory arrest <2 minutes allowing for simple intracardiac procedures
Venous inflow occlusion
Venous inflow occlusion is where you provide brief period of circulatory arrest <2 minutes allowing for simple intracardiac procedures.
What are these procedures
1) Intracardiac masses
2) Cor triatriatum
3) Cardiac foreign body
rare congenital heart defect that divides the left or right atrium of the heart into three chambers.
Cor triatriatum
-approach surgery by doing venous inflow occlusion
What are the advantages of venous inflow occlusion
1) Simple
2) Specialized equipment not required
3) Minimal systems derangement
What are the disadvantages of venous inflow occlusion
1) Very limited time available
2) Cardiac motion
3) Limited rescue options
Venous inflow occlusion indication
Curative or Palliative
Strategy for open cardiac surgery that utilizes an extracorporeal circuit to oxygenate blood and provide systemic perfusion
Cardiopulmonary bypass
What procedures can be done with cardiopulmonary bypass
1) Septal defect repair (partial or complete AVSD)
2) AV valve disease- dysplasia of mitral or tricuspid (annuloplasty band)
3) Tetralogy of Fallot
In cardiopulmonary bypass
venous cannula attached to:
arterial cannula attached to:
Venous: Jugular or r auricle
Arterial: femoral or carotid artery
What skills are needed for cardiopulmonary bypass
1) Cardiopulmonary physiology
2) Medical cardiology
3) Knowledge of perfusion
4) Systemic effects of CPB
5) Post-operative management
6) Team effort
Team
1) Surgical
2) Medical
3) Anesthesia
4) Perfusionist
5) CCU
6) Blood bank
With cardiopulmonary bypass, how can you do valve repair for mitral or tricuspid valve dysplasia
1) Artificial chordae placement
2) Annuloplasty band
With cardiopulmonary bypass, how is a partial atrioventricula septal defect repaired
Valve repair and ASD patch
What are different items to replace the atrioventricular valve with in cases of mitral valve dysplasia, MMVD, tricupsid valve
1) Bioproesthetic valve
2) Mechanical valve
3) Allograft (not available in vet patients)
Atrioventricular valve replacement can be done for
1) Mitral valve dysplasia
2) MMVD
3) Tricuspid valve disease
surgery that is performed on the beating heart using minimally invasive approaches and catheter based delivery systems under advanced imaging systems
Hydbrid cardiac surgery
What are types of hybrid cardiac surgery
1) Transcatheter Edge to Edge Mitral Valve Repair
2) Transcatheter Valve Implacement (replacement)
3) Hybrid Aortic to Pulmonary Shunt
What is V-clamp
A hybdrid cardiac surgery method where there is a transcatheter edge to edge mitral valve repair
grabbed edge of mitral leaflet and close them together, this reduces the amount of mitral regurgitation
has a canine device
10 yo MC schnauzer presented with collapsing episodes at home. He presented to a local ER and EKG was obtained, which was consistent with sick sinus syndrome (SSS). He has been diagnosed with Cushings and CKD.
WHat is best option for this dog for SSS?
Epicardial pacemaker placement
3 month old FI DSH presented for an initial check up at vet. No abnormal clinical signs. During PE, grade IV/VI continuous heart murmur at left heart base. After seeing a local cardiologist, this cat was diagnosed with PDA.
What would be the most reasonable option for Tx?
Surgical ligation without CPB
