Surgical intervention of Ischaemic and Valvular Heart Disease Flashcards
Ischaemia
Inadequate blood supply to organ or part of the body
Ischaemic heart disease
Heart problems caused by narrowed coronary arteries that supply blood to heart muscle
Aetiology of ischaemic heart disease
Atherosclerosis Embolism Coronary thrombus Congenital Arteritides Aortic dissection
Manifestations of ischaemic heart disease
Angina MI Arrhythmia Chronic heart failure Sudden death
Dangerous patterns of coronary heart disease
Left main stem stenosis
3 vessel coronary artery disease - proximal
Symptomatic coronary artery bypass grafting
Stops symptoms but doesn’t increase life expectancy
Prognostic coronary artery bypass grafting
Gets rid of angina and increase life expectancy
Symptomatic bypass grafting is performed for which coronary artery disease patterns
All
Prognostic bypass grafting is performed for which coronary artery disease patterns
Left main stem stenosis
3 vessel coronary artery disease
Selection of patients for coronary artery bypass grafting depends on
Adequate lung, mental and hepatic function
Ascending aorta and distal coronary targets are okay
Left ventricular ejection fraction > 20%
Conduits for coronary artery bypass grafting
Reversed saphenous vein
Left internal mammary arteries
Radial arteries
Sternotomy related problems
Wire infection
Painful wires
Sternal dehiscence
Sternal malunion
Post-operation problems in cardiac surgery
Cardiac tamponade
Death
Stroke
Cardiac tamponade
Accumulation of fluid in the pericardial space resulting in reduced filling of heart
Primary features of cardiac tamponade
Raised central venous pressure
Raised heart rate
Low blood pressure
Secondary features of cardiac tamponade
Oliguria (low urine)
Increased oxygen requirements
Metabolic acidosis
Treatment of cardiac tamponade
Chest re-opening
Percentage of coronary artery bypass grafting patients that have no further cardiac problems 10 years later
50%
Percentage of coronary artery bypass grafting patients who may require repeat or stent
5-10%
What valves are operated on in adult cardiac surgery
Mainly aortic and mitral
What valves are operated on in paediatric cardiac surgery
All 4
Causes of valvular heart disease in the adult
Degenerative Congenital Infective Inflammatory Ventricular dilation Trauma Neoplastic Paraneoplastic
3 commonest valve problems requiring surgery in Aberdeen
Senile tricuspid aortic stenosis
Bicuspid aortic stenosis
Degenerative mitral regurgitation
Rheumatic fever
Inflammatory disease that develops after a streptococcal throat infection
Symptoms of rheumatic fever
Skin rashes
Joint pain
St Vitus’ Dance
Treatment for rheumatic fever
Aspirin and bed rest
ASO titre
Blood test to measure antibodies against streptolysin produced by streptococcus
Chronic rheumatic heart disease
Gradually progressive mitral valve disease and/or aortic valve disease
What is the commonest heart problem worldwide
Chronic rheumatic heart disease
Endocarditis
Infection of endocardium of heart
Organism that gives rise to subacute bacterial endocarditis
Strep viridans
Organism that gives rise to acute bacterial endocarditis
Staph aureus
Indications for surgery in endocarditis
Severe valvular regurgitation
Large vegetations
Persistent pyrexia (raised body temp)
Progressive renal failure
Endocarditis post-op management
IV antibiotics for 6 weeks
Surgical management for severe aortic stenosis
Aortic valve replacement
Surgical management for severe aortic regurgitation
Aortic valve replacement
Mitral stenosis surgery is only carried out if the size of the mitral valve annulus on ECHO is less than
1.5cm2
Surgical management for mitral regurgitation
Mitral valve replacement for severe or repair for degenerative
Cardiopulmonary bypass
Machine that takes over heart and lung function during surgery
How does cardiopulmonary bypass work
Blood is drained from the right atrium and returned to the ascending aorta
Also induced hypothermia
Cardiopulmonary bypass requires
Systemic anticoagulation
During cardiopulmonary bypass flow is
Non-pulstatile
Max time limit for cardiopulmonary bypass
12 hours
Max cardiac ischaemic time
6 hours
Common problem of cardiopulmonary bypass
Coagulopathy
Advantage of closed cardiac operation like coronary artery bypass grafting over open cardiac surgical procedures like valve replacement
Air embolisms are less common
Biological valve
Lasts only 15 years but no warfarin required
Mechanical valve
Lasts for over 40 years but warfarin required for life
Warfarin
Anticoagulant
