Previous exam 2008 Flashcards
List 2 cannulation strategies and associated methods by which you can give antegrade cerebral perfusion.
List nasopharyngeal temp you want and rates and pressure
Axillary cannulation
direct cannulation of the head vessels with special balloon catheters once the arch is open
Target temp is 15-20 degress
perfusion rate is 10-15ml/kg/min ( 700 to 1500ml/min) HCT 25%
cerebral perfusion pressure is measured via the radial arterial line
LVAD implant in a patient with cardiogenic shock who had a previous CABG. Now is Hep, ASA, and POD hypotension and CVP is 15 and flow in LVAD poor. List 3 causes and treatment
Tamponade: To OR for evaculation of clot
Hypovolemia: Needs volume resuscitation
RV failure: needs inotropic support and maybe RVAD
List 3 tests you would perform for a patient with purulent pericarditis and 3 treatments
Fever
pericardial friction rub
elevated JVP
pulus paradoxus (> 10 mmHg decrease in systolic pressure on inspration
Kussmauls sign (increase in JVP in inspiration
Pericardiocentesis
Gram stain and culture
Echo
Draingage and anti-microbial
Young CABG diabetic who plans for all arterial. No SVG. 90% LAD; 60% RCA; and 90% circumflex. what grafts
RIMA to LAD
left radial to circumlex
free LIMA to RCA
risk of mediastinitis 10% if IMA is pedicled and 2.2% if skeletonized
7 day old baby who presents with failure, has systolic murmur, weak femoral pulses
Coarctation
hypoplastic arch
interrupted arch
severe AS/subaortic stenosis
treatment: IV PGEi foley/fluid intubation treat metabolic acidisosis surgical repair of lesion
3VD with poor left ventricular function. List 5 independent predictors of increased mortality in this patient CABG surgery
urgency of operation number of previous surgeries? increasing age Left ventricular ejection fraction % stenosis of leaf main number of diseased vessels with > 70% stenosis
BNP–List 3 things it does physiologically and when and where is it secreted
Brain natriuretic peptide
Mechanisms
Natriuesis/Diuresis/decrease myocardial fibrosis and remodeling
improve myocyte relaxation during diastole
inhibit renin-angiotensi system
some secreted in brain but most in ventricles.
higher levels in CHF, ACS, and pericarditis
48 year old F with asymptomatic severe AI. List 4 echocardiographic features that would make you opearate
EF < 50%
LVESD > 55ml
LVEDD > 75
Dilated ascending aorta (>5 in marfa and > 5.5 in others
Ebstein’s anomaly. List the 4 pathological findings with the tricuspod valve and annulus
Displacement of spetal and posterior leaflet towards the RV
arterialization of the RV segment between the true trucuspid annulus and the new position of the leaflet attachment
small RV
anterior leaflet that maybe large, sail like or restricted in motion
List 3 alternatives to heparin for HIT
Argatroban Bivalirudin Leupirudin Danaparoid Fondaparinux
Adult with undiagnosed PDA has eisenmengers syndrome now. What are 2 surgical options to treat this patient now
Heart lung transplant
Lung transplant
REMATCH trial list the actuarial survival of the medical therapy group
1 year: medical 25% device 52%
2 year: medical 8% device 23%
In ischemic MR list 3 beenfts of annuloplasty on the mitral valve
Prevents further annulus dilation and helps in LV remodelling
Reduces the size of the annulus allowing better copatation of the leaflets
relives tensions from the suture lines
Decrease MR
Prevent annular dilation
Restore leaflet coaptation
What are types of endoleaks
This is Type 1. Type 2: leak from flow outside the graft Type 3: leak from graft tear or defect Type 4: leak from porous graft Type 5: leak from endotension
What is intramurual hematoma
Accumulation of blood in the media of the aorta without the presence of any flow, resutling from bleeding of the vasa vasocrum into the media
1/3 develop into aortic dissection
ascending should be treated like type A dissection
decending treat medical
List most common causes of death in transplant patients at 0-30 days; 31-1 year; and > 5 years
0-30–most common is acute graft failure
30-1 year: infection
> 5 years: chronic allograft vasculopathy
List mechanisms of reperfusion injury
i) oxygen free radicals
ii) intracellular calcium overload
iii) endothelial & microvascular dysfunction
iv) altered myocardial metabolism
v) Platelet, neutrophil, & complement activation
Question on Sano shunt vs. modified BT shunt in Norwood operation and when blood flow occurred in coronaries and pulmonary arteries in both shunt. Gave you a 2x2 table and had to fill in boxes. Options were diastole, systole, or both.
Coronaries PA
Sano Both Systole
Modified BT Both Both
Cardiac resynchronization therapy question in patient with dilated cardiomyopathy. List 2 reasons why it would fail. Long question can’t remember all the details of the question.
Lead malpositioning Lead fracture Loss of capture Cardiac perforation Crosstalk Oversensing Battery end of life Inadequate LV/RV synchronization
Patient with dilated cardiomyopathy (EF<20%). Has been on “state of the art” meds. Now patient has NYHA class 3-4 failure. List 4 “state of the art” meds patient was on. List 4 non-medical treatment options for this patient.
beta blocker, ACEI, spironolactone, digoxin
CRT, CABG if pt has CAD, LVAD as destination therapy, transplant, ICD
In patient with 3VD and poor LV fxn. List 5 independent predictors of increased mortality in this patient with CABG surgery
Old age Poor LV function Preop renal failure Cardiogenic shock Emergency status COPD
intra-operative dissection occurs post ascending aortic aneurysm repair. List 3 immediate steps
Expose femoral vessel and cannulate the right common femoral artery. Change in-flow to the femoral cannula and go on bypass and cool to 20C.
DHCA to 20 degrees, pack head with ice, mannitol, circulatory arrest, trendulburg
Bring down distal anastomosis and expose aortic arch. Identify the intimal tear and resect. Bring together the intimal tear and the aortic wall with teflon felt and reconstitie the true lumen.
Recannulate with side arm the distal graft and retart CPB.
Trim and perform end to end graft.
