Previous exam (2005) Flashcards
Failure to arrest heart with antergrade cardioplegia
The problem is aortic insufficiency
Could stop, vent through the root and give again at high pressure
attempt placement of retrograde
Arterial line showing low pressure (24mmHg) ECG tracing asystole, PAP 2mmHg, retrograde has a pressure of 32 mmHg, arterial line pressure is 80mmHg.
This patient has hypotension from either vasodilation or hypovolemia
Increase pump flow
Add vasopressors
*increase fluid
Hemodynamics show a retrograde tracing of 32mmHg, and arterial line pressure of 260mmHg
Cardioplegi pressure is too high
possible etiologies kinked line catheter too far clamp on line cardioplegia not right?
rideout upper queens, kingston (straight…down and up hill. right
Patient with a coactation repair at age 5. Now with pseudoaneursym of 8 cm just distal to left subclavian
what is the method of repair at first operation?
List 4 methods to protect the spinal cord during the repair operation
Likely end to end
Hypothermia Cerebrospinal fluid drainage maintain adeuqate perfusion pressure distal perfusion support minimize ischemic clamp time preserve intercostals
What is the preferred method of repair of coarctation for
neonate?
adult?
Neonate: extended end to end; subclavian flap
Adult: interposition graft; end to end; angioplasty/stent
List 5 complications of carctation repair
Recurrent laryngeal nerve injury thoracic duct injury paralplegia paradoxical hypertension late true aneurysm pseudoaneursym intermittent visceral ischemic pain recoarctation
CT scan showing transected aorta just distal to the left subclavian
discuss appropriateness of each of the following
Open repair
Stenting
Delayed repair
Open repair: viable option for pt w/o life threatening instability or other severe life threatening injuries.
Stenting: when readily available with suitable anatomy, useful in pts with other major concomitant injuries. Becoming more common. Carries risk of endoleak, branch vessel occlusion, infection, hematoma, paraplegia, stroke
Delayed repair: when stenting not available and pt has other severe life threatening injuries.
Patient with moderate to severe secondary TR going for MV operation
What would you do? If the TR is secondary and moderate what findings sway you to no repairing
Tricuspid ring Right ventricle is normal size tricuspid annulus not dilated (<30mm) Right ventricle functioning well minimal pulmonary hypertension
Trauma pt with a large L pleural effusion, CT drained 2L of milky fluid
Likely diagnosis is chylothorax
3 tests are
TG > 1.1 mmol
Cell count: lymphocytes > 80%
Cell > 1000 microlitre
2 ways to treat medically are medium chain triglyceride diet; TPN
3 ways to treat surgically: tube thoracostomy; pleurodesis; duct ligation; pleuroperitonal drainage
List 4 post acute MI complications that are amenable to immediate surgical repair
Left ventricle perforation
rupture papillary muscle rupture
Ventricular septal defect
Cardiogenic shock secondary to heart failure
List 3 findings on a stress thallium scan that predict high likelihood of future cardiac events
Left ventricle dilation with stress
Increased pulmonary activity
Extensive reversible ischemia of multiple segments
reverse redistribution
Patient with 20% EF , LF and LAD disease, No angina, symptoms of CHF. What would you like to know about the myocardium? List 3 tests that can be used to predict benefit from revascularization
Viability
Stress thallium scan
PET scan
Sestamibi scan
Dobutamine echo
Uneventful MVR in a female. POD # 2 sudden arrest on ward. After chest compressions regains…EKG shows 1st degree AV block. What are 3 possible causes
Ventricular arrhythmia
vagal episode
AV conduction block (3rd degree)
Peri-infarct VT, VF arrest–now post op CABG X 3 month. Management is what?
If EF is restored to normal
EP study if positive AICD if negative continue post op medical management
If EF remained at 30%
AICD
List 5 echocardiographic findings of ischemic MR
displaced papillary muscle annular dilation restricted posterior leaflet motion elongated papillary muscle Rwma?(not sure what this is?)
Carpentier Classification of mitral valve pathology
I normal motion
II excessive motion
IIa restricted systolic and diastolic motion
IIb restricted systolic motion
Female patient with 21 mm aortic bioprosthesi. With respect to PPM and aortic root enlargement
1) under what indexed EFO do you expect PPM
2) What % of patients with PPM will experience residual symptoms
3) What % of these patients will experience improvement of 1-2 NHYA classes
0.85cm/m2
37% will experience residual symptoms
90% will experience improvement of 1-2 NHYA class
List 3 most common benign non-myxomatous cardiac tumors
rhabdomyoma
lipoma
papillary fibroelastoma
With respect to aortic root enlargement procedures
1) Describe the incision of a Nicks aortoplasty
2) How is a Manougian difference
3) How much annular diameter would you expect to gain from these techniques
Nicks aortoplasty: incision made in the middle of non coronary sinus up to annulus
Manouguain: incision made between the non and left coronary cusp and onto anterior leaflet of mitral valve (close to roof of LA)
Can expect 2 mm (2 sizes with a Nicks) and 4 mm with a Manougian
5 cath findings of constrictive pericarditis
square root sign of right ventricle pressure tracing during diastole inspiratory increase in right CVP prominent y descent decreased cardiac output equal CVP/PAD/PCWP/RA/PV pressure
Patient with post operative atrial fibrillation. Cannot tolerate medical treatment List 3 options at restoring sinus rhythm
DC cardioversion
Pharmacologic cardioversion
AV node ablationand permanent pacing
Patient with chronic hypertension presents with acute back pain. CT shows intramural hematoma
What is the definition and etiology of IMH?
What is the natural history of this lesion?
How would you treat?
Presence of IMH without dissection of aortic layers–two etiologies
rupture of vasa vasorum
intimal disruption with contained hematoma and no dissection
Natural history is 1/3 aneursym, 1/3 improve and 1/3 remain the same
I would treat a surgical type A IMH with surgical managment
With regards to AV managment in ascending aortic dissection with moderate AI. What are 3 options
Resuspend aortic valve
Bentall
Valve sparing aortic root replacement