Vulvular Heart Disease Surgery

Question 1

name some causes of cardiac ischemia

Answer 1

> atherosclerosis
> embolism
> coronary thrombosis
> aortic dissection
> arteritides: inflammation of the arteries
> congenital problems

Question 2

how does ischemic heart disease manifest?

Answer 2

> angina
> myocardial infarction
> arrhythmias
> chronic heart failure
> sudden death

Question 3

what should you look for when selecting patients for coronary artery bypass?

Answer 3

> adequate lung function
> adequate mental health
> adequate hepatic function
> ascending aorta is okay
> distal coronary targets are okay

Question 4

what are the conduits for coronary artery bypass graft?

Answer 4

> reversed saphenous vein
internal mammary arteries
radial arteries

Question 5

what problems can arise due to sternotomy?

Answer 5

> wire infection
painful wires
sternal dehiscence
sternal malunion

Question 6

what is sternal dehiscence?

Answer 6

when the wires from a sternotomy cuts through the sternum bone, due to osteoporosis

Question 7

what can infection under the heart lead to?

Answer 7

sudden cardiac death

Question 8

what cardiac problems can arise post op?

Answer 8

> cardiac tamponade ( abnormal pressure in the heart)
death
stroke

Question 9

what are the primary features of cardiac tamponade?

Answer 9

> raised cardiac venous pressure?
raised heart rate
low blood pressure

Question 10

what are the secondary feature of cardiac tamponade?

Answer 10

> oliguria
increased oxygen requirements
metabolic acidosis

Question 11

how would you treat cardiac tamponade?

Answer 11

re-open the chest and wash out the pericardium, stopping the bleeding

Question 12

what are the long term outcomes of post coronary artery bypass?

Answer 12

50% have no further cardiac outcomes 10 years later, those that do are minor and medically controlled.
5% of patients may require repeat coronary artery bypass surgery.

Question 13

what is the function of the cordiea tendinea?

Answer 13

they stop the leaflets from blowing back into the atrium

Question 14

name some causes of valvular heart disease?

Answer 14

> degenerative
> congenital
> infective (endocarditis)
> inflammatory
> lv/rv dilatation
> trauma
> neoplastic
> paraneoplastic

Question 15

what is rheumatic fever?

Answer 15

this is a relapsing illness related to a streptococcal infection and it’s a hallmark pathology is pancarditis.

Question 16

how is rheumatic fever treated?

Answer 16

with aspirin and bed rest

Question 17

what is the main reason cardiac surgery is undertaken in pregnancy?

Answer 17

chronic rheumatic heart disease

Question 18

what organism gives rise to sub-acute endocarditis?

Answer 18

strep viridens

Question 19

what organism gives rise to acute endocarditis?

Answer 19

staph aureus

Question 20

what is the chance that native heart valve endocarditis can be treated by antibiotics alone?

Answer 20

90%

Question 21

why is it less likely that prosthetic endocarditis less likely to be cured by antibiotics alone?

Answer 21

the prosthetic valve gives a sanctuary site for the bacteria where the antibiotics cannot diffuse through

Question 22

what indicates surgery is needed for endocarditis?

Answer 22

> severe valvular regurgitation
large vegetations
persistent pyrexia
progressive renal failure

Question 23

what is the post operative treatment for endocarditis?

Answer 23

antibiotics given intravenously for 6 weeks

Question 24

what would an aortic stenosis be replaced with in older patient?

Answer 24

an animal valve, these can wear out but the patient does not need to be on warfirin

Question 25

what would an audible mitral stenosis indicate about the condition?

Answer 25

that it is severe, the patient may need to be exercised to make it loud enough

Question 26

what is severe mitral regurgitation usually associated with?

Answer 26

left ventricular and atrial dilatation.
onset of atrial fibrillation
pulmonary hypertension

Question 27

on an ECHO what is severe mitral regurgitation associated with?

Answer 27

systolic blood flow reversal in the pulmonary veins

Question 28

describe a cardiopulmonary bypass?

Answer 28

blood is drained from the right atrium and returned to the ascending aorta, it is passed through a CPB machine that takes over the heart and lung function.
there is no pulsatile flow.

Question 29

what is the max limit of a CPB?

Answer 29

12 hours

Question 30

what problems are associated with CABG?

Answer 30

> coagulopathy

Question 31

what are the cons of a biological heart valve?

Answer 31

they wear out in 15 years

Question 32

what are the pros of a mechanical valve?

Answer 32

it lasts for over 40 years

Question 33

what are the cons of a mechanical valve?

Answer 33

warfarin is required for life

Question 34

in what cases can the mitral valve be repaired instead of replaced?

Answer 34

degenerative mitral regurgitation