Valvular HD - Surgery Flashcards
What valves are most commonly operated on?
The aortic and mitral in adults.
All equal in kids
What is rheumatic fever?
A relapsing illness occuring due to a streptococcal infection.
Commonly causes progressive Mitral & aortic valve fibrosis, skin and joint manifestations.
Treated with aspirin & bed rest
What organisms commonly cause endocarditis & associated valve damage?
Step Viridans
Staph Aureus
What kind of endocarditis is most curable?
Native Valve endocarditis is 90% curable with antibiotics (PVE is only 50%)
Strep Viridans is much more curable than Staph Aureus
In a case of Endocarditis what would indicate we should intervene surgically, instead of just use antibiotics?
IF the valvular regurgitation is severe
Vegetations are Large
Persistant Pyrexia
Progressive Renal Faiure
What do we give post operatively for endocarditis?
Antibiotics IV for 6weeks
When would we give replacement surgery for aortic stenosis, regurgitation and mitral stenosis, regurgitation?
AS - When Severe
AR - Severe, especially with LV dilatation (the entire LV will be filled with contrast in one diastole during aortography)
MS - If MVA is <1.5cm2 on an ECHO
MR - If severe MR (i.e. if systolic blood flow is reversed in the pulmonary veins on an ECHO)
How does a cadiopulmonary bypass work?
IT drains blood from the RA to the Ascending aorta. It requires induced hypothermia & systemic anticoagulation.
It artificially oxygenates and warms the blood before returning it to the aorta
Why would we choose a biological valve or mechanical valve?
Bio Valve - Valve wears out after 15 years.
Mech valve - Needs warfarin for life
What is the max time a CPB machine can be used?
12 hours
What is a common complication of open cardiac surgery?
Air embolisms.
