Previous exam 2008 Flashcards

1
Q

List 2 cannulation strategies and associated methods by which you can give antegrade cerebral perfusion.

List nasopharyngeal temp you want and rates and pressure

A

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

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2
Q

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

A

Tamponade: To OR for evaculation of clot
Hypovolemia: Needs volume resuscitation
RV failure: needs inotropic support and maybe RVAD

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3
Q

List 3 tests you would perform for a patient with purulent pericarditis and 3 treatments

A

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

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4
Q

Young CABG diabetic who plans for all arterial. No SVG. 90% LAD; 60% RCA; and 90% circumflex. what grafts

A

RIMA to LAD
left radial to circumlex
free LIMA to RCA

risk of mediastinitis 10% if IMA is pedicled and 2.2% if skeletonized

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5
Q

7 day old baby who presents with failure, has systolic murmur, weak femoral pulses

A

Coarctation
hypoplastic arch
interrupted arch
severe AS/subaortic stenosis

treatment: 
IV PGEi
foley/fluid
intubation
treat metabolic acidisosis
surgical repair of lesion
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6
Q

3VD with poor left ventricular function. List 5 independent predictors of increased mortality in this patient CABG surgery

A
urgency of operation 
number of previous surgeries? 
increasing age
Left ventricular ejection fraction 
% stenosis of leaf main
number of diseased vessels with > 70% stenosis
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7
Q

BNP–List 3 things it does physiologically and when and where is it secreted

A

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

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8
Q

48 year old F with asymptomatic severe AI. List 4 echocardiographic features that would make you opearate

A

EF < 50%
LVESD > 55ml
LVEDD > 75
Dilated ascending aorta (>5 in marfa and > 5.5 in others

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9
Q

Ebstein’s anomaly. List the 4 pathological findings with the tricuspod valve and annulus

A

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

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10
Q

List 3 alternatives to heparin for HIT

A
Argatroban
Bivalirudin
Leupirudin
Danaparoid
Fondaparinux
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11
Q

Adult with undiagnosed PDA has eisenmengers syndrome now. What are 2 surgical options to treat this patient now

A

Heart lung transplant

Lung transplant

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12
Q

REMATCH trial list the actuarial survival of the medical therapy group

A

1 year: medical 25% device 52%

2 year: medical 8% device 23%

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13
Q

In ischemic MR list 3 beenfts of annuloplasty on the mitral valve

A

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

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14
Q

What are types of endoleaks

A
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
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15
Q

What is intramurual hematoma

A

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

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16
Q

List most common causes of death in transplant patients at 0-30 days; 31-1 year; and > 5 years

A

0-30–most common is acute graft failure

30-1 year: infection

> 5 years: chronic allograft vasculopathy

17
Q

List mechanisms of reperfusion injury

A

i) oxygen free radicals
ii) intracellular calcium overload
iii) endothelial & microvascular dysfunction
iv) altered myocardial metabolism
v) Platelet, neutrophil, & complement activation

18
Q

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.

A

Coronaries PA
Sano Both Systole
Modified BT Both Both

19
Q

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.

A
Lead malpositioning
Lead fracture
Loss of capture
Cardiac perforation
Crosstalk
Oversensing
Battery end of life
Inadequate LV/RV synchronization
20
Q

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.

A

beta blocker, ACEI, spironolactone, digoxin

CRT, CABG if pt has CAD, LVAD as destination therapy, transplant, ICD

21
Q

In patient with 3VD and poor LV fxn. List 5 independent predictors of increased mortality in this patient with CABG surgery

A
Old age
Poor LV function
Preop renal failure
Cardiogenic shock
Emergency status
COPD
22
Q

intra-operative dissection occurs post ascending aortic aneurysm repair. List 3 immediate steps

A

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.