Pre-Op AS

Question 1

Male patient with history of Aortic stenosis, going for TURP is found to have ejection systolic murmur in Preoperative assessment.

Q1: What is the diagnosis?\

Answer 1

AS

Question 2

Q3: What is the Symptoms?

Answer 2

Asymptomatic in mild
Moderate – > syncope, angina pain , dyspnea, LL edema, Paroxysmal nocturnal dys
Sever – > heart failure and sudden death

Question 3

Q2: What is the Pathophysiology of Aortic Stenosis ?

Answer 3

Incr. in After load causing LV hypertrophy – pt will have fixed COP leading to limited coronary blood flow – cannot fulfill increased demand that happen with anathesia or blood loss

Question 4

Q4: What is the Complications you expect?

Answer 4

LV hypertrophy – LL edema – CHF – Sudden death

Question 5

Q. ECG changes of AS?

Answer 5

• Signs of LV hypertrophy; Large R-waves in left-sided leads (V5, V6, I and aVL) and deep S-waves in right-sided leads (V1, V2)
• Lt axis deviation by +VE QRS in Lead 1
• Heart Block
• ST segment Depression

Question 5

Q6. What is the Intra-op complications which can lead to death?

Answer 5

Acute MI – Aortic Dissection

Question 6

Q7. Anesthetic considerations?

Answer 6

Pt may have cardiac arrhythmia – LV hypertrophy – HF all of these can lead to complication like MI / Aortic Diss – > Death

Question 7

Q5. how syncope occur in patient with AS ?

Answer 7

Fixed COP – Incr activity – Limited blood supply to brain in response to demand – Syncope.

Question 7

Q9: Findings in this ECG?

Answer 7

LV hypertrophy , ST depression , H.Block
x

Question 7

Q8: Pre-op investigation to do?

Answer 7

CXR – 2D ECHO – Transesophageal ECHO – Coronary Angio (to role out dissection and for fear of MI)

Question 8

Q12: Guidelines what to do first, AS valve replacement or bladder surgery?

Answer 8

Depndes on the surface area(N; 2.5-3.5 of the valve if less than 1 cm – > Aortic Valve Replacment first

Question 9

Q10; How to Calculate HR in this ECG?

Answer 9

Big squares btw RR and divide 300 / RR
75

Question 9

Q11: Advantages and disadvantages of doing AS surgery first vs doing cancer surgery first?

Answer 9

Adv; could avoid AS complications dis; Spread of malignancy

Question 10

Q13: Antibiotic prophylaxis?

Answer 10

NICE guidelines – No need for Abx unless pt is going for highly inf. Procedure (upper/Lower GI) OR have recurrent IE
Sign Guidelines – No need for Abx in any case.

Question 11

Q14. Types of valves in valve replacement ?

Answer 11

Mechanical / Tissue type x

Question 12

Q15: Difference between each of them ?

Answer 12

Mech; more durable, noisy, long term anticoagulant prophylaxis For life
Tissue; less durable, less noisy, short term anticoagulant pro. 3 month

Question 13

Q16: what is the non surgical options for valve replacement?

Answer 13

Transcatheter valve replacement
Valvuplasty & ballooning

Question 14

Q17. what is aortic sclerosis ?

Answer 14

Aortic Valve disease without significant gradient across the valve that may progress to stenosis.

Question 15

Q. labs findings could delay the surgery?

Answer 15

Hypokalemia and hyponatremia