Previous exam 2012 Flashcards
List 4 advantages of TEVAR over open repair for traumatic rupture
avoidance of a thoracotomy
avoidance of the systemic effects of cardiopulmonary bypass
avodiance of spinal ischemia
avoidance of cross-clamping
avoidance of single lung ventilation
should result in decrease in perioperioative mortality and complications
page 1149 cohn
List 4 possible procedural challenges with TEVAR for traumatic tear repair
Adequate proximal landing zone (need 1.5cm for seal)
heavily calcified arch
small radius of curvature
access related complications–too large of graft delivery system
page 1151
70 year old patient with type B dissection
List 3 management principles
What is risk of death over the next 3 years if patient is discharged home
surgical management 50% mortality with 30% in medical
control the heart rate and blood pressure to decrease shear stress on aorta and limit expansion of the false lumen and propagation of dissection
Pain control
Beta-blockers
follow-up clinical assessment at 3 and 6 months
Medical management has a 1 year survival rate of 85% and a 5 year 71%
page 1015
patient post acute anterior MI can’t wean off CPB–place an LVAD
patient become cyanotic (shunting), which is the most likely cause
List 3 intracardiac lesions to repair during LVAD insertion
Most likely cause is a PFO
Important anatomical abnormalities include
- PFO
- Aortic insufficiency
- repair tricuspid valve
- removal of LV thrombus to prevent systemic embolization
page 1364
Severe asymptomatic aortic stenosis
What is risk of mortality over the next year
What is likelihood of developing symptoms in the next year
In AS what is the rate of decrease in the valve area per year
symptomatic patients have a 10%/year sudden death average survival 3 years with symptoms
Asymptomatic have a less then 1% rate of sudden death per year
overall 7% of asymptomatic patients with AS experience death or AVR 1 year after diagnosis
The average decrease in AVA is 0.12cm2/year resulting in a average increase in transvavular gradient of 10 to 15mmh
page 696 cohn
Doing a study to look at risk factors for stroke after cardiac surgery. You create a receiver operator curve to test your model
What is on the x0axis and the y0axis of graph
What does the C-index mean
The C-index is 0.59, the assistant says that means it it is a good model.
Is this true or false
Explain your answer
X axis : false positive or 1- specificity
Y axis : true positive or sensibility
C index is area under the curve
It will vary between 0.5 to 1
An index over 0.7 mean an acceptable correlation
What determines the classification of double outlet right ventricle?
List the 4 types of DORV
DORV-50% rule, that a heart is termed DORV if in addition to the PA more then 50% of the aorta arises in the RV. No aorta-to-mitral valve continuity
The classic pathologic classification of DORV centers on location of VSD.
- DORV with subaortic VSD
- . DORV with subpulmonic VSD
- Doubly committed
- Non committed
53 year old pt, diabetic, want to do arterial revascularization, has previosuly had saphenous vein stripping (LAD 80%, RCA 60%, Circumflex 90%)
List conduits to use and where you would put them
Risk of mediastinitis in a diabetic patient
left internal thoracic artery
right internal thoracic arery
Low rates of sternal infection with BITA about 1.7% (if skeletonized…) overall about 2.6% in diabetics when skeletonized. A pedicle harvest is about 4.5%
Diabetic pts derive the greatest benefit as it was shown to be 10% in non skelentonized vs 2.2 in skeletonized
cohn book…
Questions about plavix... What class of medication is plavix and list 2 other drugs in the same class
What is the mechanism of action of plavix, include the mechanism and receptor it acts on
List 3 ways to decrease blood loss due to plavix, either pre-operatively or intra-operatively
Plavix is an adenosine diphosphate (ADP)inhibitor . It blocks platelet ADP P2 Y12 receptors inhibiting platlete activation by prevetning ADP mediated responses, decreasing
Two other drugs in same class
Prasugrel (EFFIENT)
Ticagreloar(Brilinta)
congrelor (intravenous)
page 336 cohn
Patient found in dumpster at -11 degrees. Patient is getting CPR and is cold
List 4 interventions to rewarm other than CPB
Give two cannulation and perfusion strategies to rewarm with CPB
Warm blanket
Warm IV fluid
Hot gastric lavage
Hot peritoneal lavage
Cannulation fem-fem, arteriovenous because CPR
Fem- jug, venovenous only if perfect hemodynamics
List 3 classes of drugs that are basis of transplant immunosuppression
Calcineurin inhibitors (cyclosporine and tacrolimus)–inhibit IL-2
Purine synthesis inhibitors (MMF, Azathoprine)
corticosteroids, which inhibit cytokines (IL1- TNF)
Monoclonal antibody that binds to CD3 receptor on T-lymphocytes (OKT3)
What is mechanism of action of factor VII
Two things that must be done before giving factor VII
Most likley complication
recombinant activated factor VII complexes with all avilable tissue factor to activate factor X directly and induced thrombin generation. Leads to formation of a tight and stable fibrin plug that is resistant to early fibrinolysis
most likely complication is thrombosis
two things that must be done?
- warm
- correct acidosis
page 335
Patient 3 hours post transplant, swan shows low CI, CVP 25, wedge 6
List 2 ventilator strategies that will help this patient
List 3 classes of IV medications that are indicated in this patient
Phophodiesterase inhibitor
Epinenphrine
Inhaled nitric oxide
Correct hyoxia
avoid hypercapnia
70 year old pt with 16 year history of smoking, diabetes, presents with heart failure, ETT whos EF 25%, 2:1 block with variable 3rd degree block. Cath shows not revascularizable.
List 3 possible pacing modes for this patient
List 2 other intestigations that will help you decide on the best pacing mode for this patients
What pacing mode should be chosen for this patient
DDD; CRT; DVI
echo, ecg, viability
CRT
CANMED question: JW signed refusal of transfusion preop. Now needs transfusion to survive. When meeting the family what 2 CANMEDS roles could you provide and list 3 key elements for each
Communication
Professional
List 3 pathophysiological mechanims and an example for each that lead to secondary tricuspid regurgitation
annular dilation
rv infarction
primary PHTN
STEMI–mildy elevated trops, cath showing severe left main and 3VD. Don’t want to PCI. Cannot operate now.
List 3 constructive things you can do to help this patient before going to OR
Insert IABP
Anticoagulation treatment
dual anti-platelet therapy
transfer?
List 3 ideal indications for aortic valve repair (exam wording) and 3 most common aortic valve repair techniques
young age
normal leaflet tissue
no calcium, no fenestrations
No stenosis
List 4 characteristics of a patient that would most benefti from CRT based on randomized trials
viability QRS> 150 low EF 35% NHYA III-IV no structural/IHD
