TSRA Question Bank Flashcards
Transeptal mitral approach puts what structures in danger?
When is it most advantageous?
Kugel’s artery and Bachman’s bundle (off SA node on SVC to L side/ interatrial band, aka b/w the SVC and aorta).
Used for concomitant tricuspid, bi-atrial enlargement, previous mitral surgery through interatrial groove
Where does persistent L SVC drain?
Coronary sinus.
Need to clamp during retrograde cardioplegia.
Eval innominate vein.
May need to cannulate.
What is the primitive heart loop?
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.
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?
Diaphragmatic injury. Do dx lap.
Which “chest” fracture has a 70% rate of concomitant injury?
nondisplaced scapular fracture
What should PA pressure goal be in pt after CPB (assuming no pulm HTN preop)?
<25 mmHg
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)?
Like an MI: TTE, EKG, CXR, cardiac enzymes
What can be used to calculate SVR?
What is formula?
What are normal values?
MAP, CVP, CO.
SVR = 80(MAP-CVP)/CO.
Should be 800-1200.
If you don’t use anticoag during ECMO, what are the risks?
Limb ischemia, circuit failure, system thrombosis
O2 sat of 80-85% is most likely seen after which stage of single ventricle palliation (congenital)?
bidirectional Glenn or hemi-Fontan
In congenital heart surgery, stenting of the PDA offers an alternative to surgical shunt creation and offers potential benefits. What is a disadvantage?
May distort PAs at its PA insertion
What can TTE show (and not show) for surgical planning for ToF?
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.
In congenital heart surgery, palliative operations seek to address which goals?
provide symptomatic relief and minimize the disorder
What are characteristics of effective shunts in cardiac surgery?
easily reversible, good functionality and patency, technical simple
Coronary artery anomaly rate in ToF?
Most common?
Where does the most common type of this anomaly lie, and where can it be damaged?
5-10%. Most common is LAD from RCA.
Traverses RVOT and can be damaged during infundibulotomy or transannular incision
Lateral tunnel Fontan compared to extra cardiac Fontan?
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.
Is repair of partial anomalous pulmonary venous return a palliative procedure?
No. It addresses the underlying pathology with a definitive operation.
Most common type of VSD in tetralogy of Fallot?
Perimembranous.
Primary anatomical derangement in ToF?
Anterior and leftward displacement of the infundibular septum -> affects primary R V-A junction.
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?
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.
After completion of the repair of subaortic DORV, there is RV dysfunction coming off CPB. Factor for RV dysfunction?
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.
Usual length of idiopathic laryngotracheal stenosis?
2-3 cm. Range from 0.5-5 cm.
Pt has first spontaneous PTX. CTb is placed, but there is a persistent air leak for 3 days. What should be done?
VATS pleurodesis
During tracheal resection for cancer, it is discovered that the RLN on one side is involved. What should be done?
Mediastinal and perivascular fascia - should be resected routinely?
One side can be sacrificed if the contralateral is preserved.
Mediastinal and perivascular fascia should not be resected routinely.
