Sako it to me
You Aorta Know
A Bar/A Ban/A Knell
How Gauthier
Johnson & Johnson
100
This is the structure at risk of inury when a stitch is placed near the anterolateral trigone during mitral valve surgery.
What is the circumflex artery?
100
Patients with Loeys-Dietz syndrome and aortopathy have a mutation in the genes that encode these receptors.
What are TGF-βR1 and TGF-βR2?
Bonus: What type of mutation and what happens to TGF-β signaling in Loeys-Dietz?
Heterozygous loss-of-function mutation; there is paradoxical increase in TGFβ signaling resulting in increased ECM deposition degradation.
100
This is the index and threshold for repair of pectus excavatum.
What is a Haller/Pectus index > 3.25?
100
This area where N2 nodes reside is considered the "sump area' for left upper lobe cancers (name both the area and station).
What is the aprtopulmonary window / Station 5.
100
In addition to prostaglandin E2, this prostaglanding helps maintain ductal patency in the fetus.
What is prostacyclin or PGI2?
200
This is the Carpentier class most associated with left ventricular dysfunction related mitral regurgitation.
What is Class IIIB?
200
Deep hypothermic circulatory arrest exceeding this time period should prompt consideration of adjunctive cerebral perfusion.
What is 25 minutes?
Source: STS E-book
Bonus: What are the goal flow rate and pressures for ACP and RCP?
ACP: 10 mL/kg/minute; right radial pressure of 40-70 mm Hg.
RCP: 200-300 mL/min; RIJ pressure of 25 mm Hg
200
This is the time range for holding novel oral anticoagulants before cardiac surgery.
What is 2-4 days?
Source: Preoperative medication management turnkey order set for nonemergent adult cardiac surgery
https://doi.org/10.1016/j.xjon.2024.06.009
200
This type of protamine reaction is mediated by Thromboxane A2 and presents as severe hypotention, elevated PA pressures, and acute RV failure.
What is Type III?
300
This echo finding in the pulmonary venous inflow is characteristic of moderate mitral regurgitation.
What is systolic blunting?
300
For chronic aortic aneurysms, this pharmacologic agent has been shown to have benefit in this population.
What are beta-blockers; what are patients with Marfan's syndrome?
Benefit not reproduced in other studies of adults, pediatric, with Marfan
No convincing evidence of losartan, statins, or doxycycline benefit yet in in human trials.
Source: STS-Ebook "Pathophysiology of the Thoracic Aorta); citation Shores J, Berger KR, Murphy EA, et al. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. N Engl J Med. 1994;330(19):1335-41
300
This class of antibiotics may be contraindicated in patients with aortopathy.
300
These were the two preoperative chemotherapy agents used in the CROSS trial.
What are carboplatin and paclitaxel?
BONUS: What did the CROSS trial demonstrate?
400
***These are 2 of the echocardiographic risk factors for systolic anterior motion (SAM) after mitral valve repair.
What are:
C-SPAM
C-sept distance < 25 mm
Septal thickness (basal IVS > 15 mm at end-systole)
Posterior leaflet > 15 mm
Anterior:Posterior leaflet height < 1.3
Mitral-aortic angle <120° at onset of systole
Intraop factors
Tall residual posterior leaflet (>15 mm )
Small prosthetic ring
400
In the pathology shown here, the most common sinus involved and the most common chamber of fistulization.
What are the right sinus and right ventricle.
Right sinus --> Right ventricle
Left sinus --> PA or left ventricle
Noncoronary sinus --> right atrium
400
These 2 classes of drugs are contraindicated in obstructive cardiomyopathy.
What are vasodilators and inotropes?
Vasodilators: Nitrates, ACE-i/ARBs, dihydropyridine calcium channel blockers
Inotropic agents: Digoxin, dobutamine, dopamine
TIP: Dihydropiridine CCBs end in "dipine" (Amlodipine, nifedipine, nicardipine, clevidipine) and are predominantly smooth muslce dilators
Nondihydropirine CCBS are Verapamil and Diltaizem and have predominantly cardiac effects (decreased inotropy, decreased chronotropy, decreased AV nod conduction velocity,)
500
This surgeon performed the first mitral annuloplasty under direct vision in 1957
Who is C. Walton Lillehei?
500
***These are 2 absolute indications for preoperative carotid-subclavian bypass when the left subclavian artery will be covered by a TEVAR.
What are:
Patent LIMA-LAD
Hemodialysis via LUE fisutla
Dominant left vertebral artery
Prior infrarenal aortic repair with ligation of lumbar & middle sacral arteries
Planned long-segment (>20 cm) coverate of DTA where critical intercostal arteries originate
Occluded hypogastric arter
500
This is the 20-year survival rate after repair of ccTGA.
What is 50-80%?