Valvular HD - Surgery

Question 1

What valves are most commonly operated on?

Answer 1

The aortic and mitral in adults.

All equal in kids

Question 2

What is rheumatic fever?

Answer 2

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

Question 3

What organisms commonly cause endocarditis & associated valve damage?

Answer 3

Step Viridans

Staph Aureus

Question 4

What kind of endocarditis is most curable?

Answer 4

Native Valve endocarditis is 90% curable with antibiotics (PVE is only 50%)
Strep Viridans is much more curable than Staph Aureus

Question 5

In a case of Endocarditis what would indicate we should intervene surgically, instead of just use antibiotics?

Answer 5

IF the valvular regurgitation is severe
Vegetations are Large
Persistant Pyrexia
Progressive Renal Faiure

Question 6

What do we give post operatively for endocarditis?

Answer 6

Antibiotics IV for 6weeks

Question 7

When would we give replacement surgery for aortic stenosis, regurgitation and mitral stenosis, regurgitation?

Answer 7

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)

Question 8

How does a cadiopulmonary bypass work?

Answer 8

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

Question 9

Why would we choose a biological valve or mechanical valve?

Answer 9

Bio Valve - Valve wears out after 15 years.

Mech valve - Needs warfarin for life

Question 10

What is the max time a CPB machine can be used?

Answer 10

12 hours

Question 11

What is a common complication of open cardiac surgery?

Answer 11

Air embolisms.