TSRA Question Bank

Question 1

Transeptal mitral approach puts what structures in danger?

When is it most advantageous?

Answer 1

Kugel’s artery and Bachman’s bundle.

Used for concomitant tricuspid, bi-atrial enlargement, previous mitral through interatrial groove

Question 2

Where does persistent L SVC drain?

Answer 2

Coronary sinus.

Need to clamp during retrograde cardioplegia.

Question 3

What is the primitive heart loop?

Answer 3

The cardiac loop is developed by day twenty-eight. At its caudal pole it receives venous drainage and pumps blood out of its cranial pole into the dorsal aorta via the first aortic arch. It is made up of a series of dilations – the bulbus cordis, primitive ventricle, primitive atrium and sinus venosus that develop under the influence of homeobox genes.

Question 4

A patient is stabbed in L flank. He is otherwise ok w/o injury on CXR. What is he at risk of? What should be done next?

Answer 4

Diaphragmatic injury. Do dx lap.

Question 5

Which “chest” fracture has a 70% rate of concomitant injury?

Answer 5

nondisplaced scapular fracture

Question 6

What should PA pressure goal be in pt after CPB (assuming no pulm HTN preop)?

Answer 6

<25 mmHg

Question 7

How do you manage a blunt cardiac injury in a stable patient (ie MVC pt psx w/ chest pain and wide QRS on monitor, stable)?

Answer 7

Like an MI: TTE, EKG, CXR, cardiac enzymes

Question 8

What can be used to calculate SVR?
What is formula?
What are normal values?

Answer 8

MAP, CVP, CO.
SVR = 80(MAP-CVP)/CO.
Should be 800-1200.

Question 9

If you don’t use anticoag during ECMO, what are the risks?

Answer 9

Limb ischemia, circuit failure, system thrombosis

Question 10

O2 sat of 80-85% is most likely seen after which stage of single ventricle palliation (congenital)?

Answer 10

bidirectional Glenn or hemi-Fontan

Question 11

In congenital heart surgery, stenting of the PDA offers an alternative to surgical shunt creation and offers potential benefits. What is a disadvantage?

Answer 11

May distort PAs at its PA insertion

Question 12

What can TTE show (and not show) for surgical planning for ToF?

Answer 12

Most important imaging.
Confirms presence of four cardinal lesions, MCAB pattern, presence of other cardiac defects, RVOT obstruction.
Pulmonic circulation distal to the main PA is not well visualized by echo.

Question 13

In congenital heart surgery, palliative operations seek to address which goals?

Answer 13

provide symptomatic relief and minimize the disorder

Question 14

What are characteristics of effective shunts in cardiac surgery?

Answer 14

easily reversible, good functionality and patency, technical simple

Question 15

Coronary artery anomaly rate in ToF?

Answer 15

5-10%. Most common is LAD from RCA.

Traverses RVOT and can be damaged during infundibulotomy or transannular incision

Question 16

Lateral tunnel Fontan compared to extra cardiac Fontan?

Answer 16

Performed by creating an intra-atrial baffle from IVC to PA and can be done at earlier age d/t potential for growth. Requires CPB. Not superior.

Question 17

Is repair of partial anomalous pulmonary venous return a palliative procedure?

Answer 17

No. It addresses the underlying pathology with a definitive operation.

Question 18

Most common type of VSD in tetralogy of Fallot?

Answer 18

Perimembranous.

Question 19

Primary anatomical derangement in ToF?

Answer 19

Anterior and leftward displacement of the infundibular septum -> affects primary R V-A junction.

Question 20

Baby brought to the ED w/ tachypnea and FTT. CXR shows cardiomegaly. EKG shows q-wave leads in I, aVL, V5-6, ST-segment elevation, and t-wave inversion. What is diagnosis?

Answer 20

ALCAPA.
R cor becomes dilated and tortuous as collaterals develop to the L system.
PA resistance falls after birth -> reversal of blood through L cor -> ischemia -> FTT, wheezing, tachypnea, shock, cardiomegaly on CXR.

Question 21

After completion of the repair of subaortic DORV, there is RV dysfunction coming off CPB. Factor for RV dysfunction?

Answer 21

Baffle obstruction of RVOT.
DORV operations are complex w/ long cross-clamp times.
RV is generally hypertrophied, stiff, and poorly compliant. Take care for myocardial protection.
LV hypertrophy can result from subaortic stenosis or residual uncorrected pulmonary stenosis.

Question 22

Usual length of idiopathic laryngotracheal stenosis?

Answer 22

2-3 cm. Range from 0.5-5 cm.

Question 23

Pt has first spontaneous PTX. CTb is placed, but there is a persistent air leak for 3 days. What should be done?

Answer 23

VATS pleurodesis

Question 24

During tracheal resection for cancer, it is discovered that the RLN on one side is involved. What should be done?

Answer 24

One side can be sacrificed if the contralateral is preserved.
Mediastinal and perivascular fascia should not be resected routinely.

Question 25

What is the effect of LDCT screening for NSCLC (relative risk reduction)?

Answer 25

20% relative risk reduction for mortality compared to CXR. CT detected more cancer and at earlier stages. False positive rate was >90%. NNT to prevent a death was 320.

Question 26

Is remote history of pleurodesis a contraindication for LVRS?

Answer 26

Yes. Any history of prior thoracic surgery is a contraindication.

Question 27

NSCLC invades the chest wall. What is T stage?

Answer 27

T3

Question 28

Most common complication following caustic ingestion?

Answer 28

Stricture. 50% of pts.

GOO, perforation, and cancer are other potential complications.

Question 29

Thoracic sympathectomy is done for axillary hyperhidrosis (BL R4 and R5). What is the most common complication and its tx?

Answer 29

compensatory sweating - torso, thighs, legs
reassurance is management
risk factors: division above R2, multiple level sympathectomy, axillary sweating, high BMI, older

Question 30

What luminal diameter in tracheal stenosis is usually required to cause dyspnea at rest?

Answer 30

5-6mm

Question 31

Cerebral protection can be purely hypothermic during circulatory arrest. How is this achieved?

Answer 31

18 degrees.
Via nasopharyngeal temperature.
Cool to temp for 30 mins when EEG becomes flat (or for 45 min empirically, ie w/o EEG).
30 mins to perform repair.

Question 32

You cause a type A dissection during cannulation. What do you do next?

Answer 32

Cerebral and systemic perfusion must be achieved - cannulate somewhere else - fem or ax.

Question 33

Optical med mgmt of chronic systolic HF includes what meds?

Answer 33

beta block
diuretics
ACE-inh

Question 34

Cardiac rhabdomyomas in children associations?

Answer 34

Most common primary cardiac tumor.
Occur w/ tuberous sclerosis in 50% of pts.
Multicentric and within ventricles.

Question 35

Medical mgmt of CAD?

Answer 35

ASA in all.
ASA and plavix if prior ACS or PCI.
Aldosterone blockade if hx of MI w/ low EF w/o CKD.
ACEi for EF <40% OR DM OR HTN.
ARB if hx of MI or HF if intolerant to ACEi.

Question 36

A patient is undergoing CABG and surgical ventricular remodeling. There is severe MR. What is your plan for approach to MR?

Answer 36

Aneurysm ventriculostomy to do mitral valve repair first. SVR. CABG.

Question 37

AV groove disruption after mitral surgery.
Presentation?
Risks?
Prevention?

Answer 37

Psx: several minutes after coming off bypass, large amount of dark blood welling up from posterior pericardium.
Risks:
Pts w/ extensive calcification of the posterior mitral leaflet and annulus.
Lifting and retracting the heart after replacement.
Prevention: posterior leaflet preservation and chordal-sparing techniques.

Question 38

3 most common causes for pericardial effusion?

Answer 38

neoplasm, idiopathic, uremia

Question 39

Define the sensing threshold for a pacemaker.

Answer 39

Minimum myocardial voltage required to be detected by the device as a P or R wave, measured in mV. It’s higher for ventricles.

0. 4-10 mV for atria.
1. 8-20 mV for ventricles.

Question 40

Which part of the aorta is most commonly aneurysmal in Marfan patients?

Answer 40

Root