Previous Exam 2005 Flashcards
4 etiologies for high line pressure when on bypass
partial outflow obstruction malpositioning cannula partial clamping of cannula kinking of cannula aortic dissection
List 4 reasons why you have to tell patient about a life threatening illness that wife doesn’t want you to tell
beneficience
autonomy
justice
nonmalficience
Pt with coarctation repair at age 5. Now with pseudoaneursyn of 8 cm distal to left subclavian.
What was the method of the first operation
What are 4 ways to prevent paraplegia
likely a patch aorto-plasty
other options
resection with end to end anatomosis
resection with insertion of interposition graft
patch aortoplasty
subclavian-flap aortoplasty
4 ways to prevent paraplegia
CPB with hypothermic circulatory arrest
reattachment of thoracic and segmental intercostals and lumbar arteries (T8-L1)
sequential aortic clamping
CSF drainage
left heart bypass
measurement of sensory and motor evoked potentials.
List 5 complications of coarctation repair
recurrent larnygeal nerve injury paraplegia chylothorax Horners sydrome re-coarctation anastomotic aneurysm
28 year old with transected aorta in MVC. Discuss appropriate for
Open repair
Stenting
Delayed repair
Open: recommended in stable patients not requiring laparotomy, craniotomy, or pelvic stabilitzation. If no other life-threatening injuries, it is the gold standard
Stenting: maybe used to those who cannot undergo immediate open repair. avoids heparin. allows patients to undergo simultaneous repair, avoids single lung
Delayed repair
Patient with moderate to severe secondary TV going for MV operation
What would do you to TV
if TV is secondary and modearte what are some things that will sway you towards not repairing the TR
Indications
Severe primary or secondary TR in symptomatic pts not responding to meds
severe TR in pts underging MV surgery
mild or moderate TR in patients with dilated annulus (> 40mm)
Would not operate if there is absence of RV dilation absence of RV dysfunction emergent OR for acute MR if repair is not feasible and you would have to replace
Trauma pt with large L pleural effusion. CT drained 2L of milky fluid What is diagnosis What 3 tests would confirm 2 ways to treat medically 3 ways to treat surgically
Chylothorax
Fluid for chylomicrons, high TG, lymphocytes
Medical treatment TPN + NPO Medium-chain fatty acids octreotide Surgical treatment thoracic duct ligation--between 8 and 12th thoracic vertebrai--usually through right chest pleurodesis pleuroperitoneal shunt
List 4 post acute MI complications that are amenable to immediate surgical repair
ischemic MR Ventricular rupture Ischemic VSD LV aneurysm (false and true) cadiogenic shock
List 4 findings on stress thallium that can predict high likelihood of future events
Pulmonary captation (?)
reversible LV dilation
mult-teritory involvement
Pt with 20% EF with LM 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
Viabilitity studies—assess if hibernating myocardium
Thallium, PET, MRI, Dobutamine
Uneventful MVR in a female. POD # 2 sudden arrest on ward. After chest compressions, she regains consciouness with no neurologic deficit. HR and BP are normal. EKG 1st degree AV block
3 possible causes
Tamponade Arrhytmias valve thrombosis/dysfunction vaso-vagal stroke TIA transient ischemia
List echo findings of ischemic MR
Papillary muscle displacment (posterior and inferior) Ventricular dilation Seagull deformity of anterior leaflets annular dilation (posteior dilation) leaflet tethering
Classification of Mitral valve pathology
.
Female pt with 21 aortic bioprosthesis. Under what indexed EFO do you expect PPM
What percentage of patients with PPM will experience residual symptoms
What percentage of these patients will experience improvement in 1-2 NHYA classes
0.85cm2/m2 for mismatch. Severe is .65cm2/m2
30% of patients with PPM will have residual symptoms
List 3 most common non myxomatous cardiac tumors
lipoma
papillary fibroelastoma
hemangioma
rhabdomyoma * in kids*
Common malignant tumors
angiosarcoma
rhabdomyosarcoma
meotheliomo
fibrosacroma
With respect to aortic root enlargement procedures
Describe the incision of a Nicks
How is manougian different
How much annular diameter would you get from these techqniues
Nicks–through the non-coronary sinus into annulus
Manougian
in comissure b/w LCC and NCC and continues down to anterior leaflet of mitral valve
1 valve size (2mm) for a Nics
2 sizes (4mm) for Manourgian
List 5 cath findings of constrictive pericarditis
equalization of pressures (LVEDP and RVEDp are within 5 mmHg)
elevation of mean atrial pressure (> 10 mmhg is suggestive of tamponade or constriction)
square root sign (on ventricular pressure tracing: gradual onset of diastolic filling is interrupted by an abrupt dip as the ventricle encounters constrictive pericardium)
prominent Y descent (in right atrial tracing)
elevated RVEDP (> 1/3 RVESP)
left ventricular ejection fraction is > 40%
Patient with post op AF and cannot tolerate meds. List 3 other options
Cardioversion
ablation with pacing
OR for maze
Pt with an intramural hematoma. What is the definition and etiology? What is the natural history? How would you treatm?
Collection of blood in the media of the aortic wall without flap or flow
etiology–rupture of vaso vasorum or penetraiting atherosclerotic
Natural history–33% mortality for ascending aorta, 9.7% for descending aorta
If anasecnding aorta then treat like a type A. if in descending then treat like a type B
What are options for ascending aortic dissection with moderate AI
Bentall
Supracoronary tube graft
Aortic valve repair (reimplantation vs remodeling)
