valvular heart disease surgical treatment

Question 1

what is the criteria for a patient receiving a CABG?

Answer 1

They need to have adequate lung function, mental function and hepatic function
Ascending aorta ok
Distal coronary targets ok
LV EJ >20%

Question 2

what is the most dangerous pattern of coronary artery disease?

Answer 2

left main stem stenosis because this means it will affect 3 main coronary vessels- LAD, circumflex and posterior IV arteries.

Question 3

what are the conduits for CABG?

Answer 3

Reversed saphenous vein
Internal mammary arteries
Radial arteries

Question 4

when harvesting the saphenous vein for a CABG, what do you have to be aware of?

Answer 4

veins, such as the saphenous vein, have valves, therefore you have to be aware of the orientation of the valve before it is removed to ensure the blood doesn’t flow the opposite way when it is put in the heart

Question 5

what is the maximum time someone can be on by pass for and why?

Answer 5

12 hours because over this time it can cause haemolysis of red blood cells (rupture/destruction)

Question 6

state some of the problems related to sternotomy.

Answer 6

wire infections e.g. mediastinitis (infection of the sternum)
painful wires
sternal dehiscence
sternal malunion

Question 7

what are some of the post op problems associated with cardiac surgery?

Answer 7

cardiac tamponade
stroke
death

Question 8

what are the primary features of cardiac tamponade following cardiac surgery?

Answer 8

Raised JVP
Raised heart rate
Low BP

Question 9

what are the secondary features of cardiac tamponade following surgery?

Answer 9

Oliguria (low urine output)
Increased 02 requirements
Metabolic acidosis

Question 10

what organisms gives rise to sub acute bacterial endocarditis?

Answer 10

strep viridans

Question 11

what organism gives rise to acute bacterial endocarditis?

Answer 11

strep aureus

Question 12

endocarditis caused by which organism has the higher chance of cure?

Answer 12

strep viridans

Question 13

what are the indications for surgery in endocarditis?

Answer 13

severe valvular regurgitation
large vegetations
persistant pyrexia
progressive renal failure

Question 14

how long are ant biotic given post operatively from endocarditis surgery?

Answer 14

6 weeks

Question 15

what differentiates aortic stenosis from aortic sclerosis?

Answer 15

in aortic stenosis there is loss of aortic S2

Question 16

describe cardiopulmonary bypass.

Answer 16

blood is drained from the right atrium to the ascending aorta.
the CPB machine takes over the function of the heart and lungs.
Induced hypothermia in order to decrease 02 demand from tissues.
Systemic anti coagulation is necessary

Question 17

what is a common problem with open cardiac procedures such as valve replacement?

Answer 17

air embolism

Question 18

what are the pros and cons of biological valve replacement?

Answer 18

no warfarin

valve wears out after 15 years

Question 19

what are the pros and cons of mechanical valve replacement?

Answer 19

warfarin required for life

valve lasts for more than 40 years

Question 20

when is valve repair better then valve replacement?

Answer 20

In many cases of degenerative Mitral regurgitation after complete valve competence is restored.