CTS Jeopardy 26 Round 2

Always Bett on the Hausen

600

***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

800

***These are the 6 variables from an esophageal pH test used to calculate the DeMeester score.

What are
1. # of episodes of reflux,
2. % time < pH 4,
3. % time supine < pH 4,
4. % time upright < pH 4,
5. duration of longest reflux episode
6. # lasting > 5 minutes?

1000

***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

You Aorta Know

200

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.

400

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

600

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

 

800

In the pathology shown here, this 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

H(e)ar(t)ville

200

This structure of collagen fibers is a continuation of the Eustachian and Thebesian valves.

What is the tendon of Todaro?

400

This structure connects the right bundle branch to the anterior tricuspid papillary muscle.

What is the moderator band?

600

Left ventricular traction contributes to this % of right ventricular cardiac output .

What is 20-40%

Calhoon Called Who?

200

This surgeon in 1769 described the anterior diaphragmatic defect that carries his name.

Who is Giovanni Morgagni?

400

In 1958, this surgeon from Yale University performed the eponymous SVC-rPA anastomosis.

Who is William Glenn?

600

This Japanese surgeon described a modification of the Norwood procedure in 2003 by replacing the BT shunt with an RV-PA conduit

Who is Shunji Sano?

800

This surgeon from Chicago performed the eponymous operation which creates a shunt from the descending throacic aorta to the left pulmonary artery

Who is William Potts?

1000

This eponymous operation is used with D-TGA exists with LV outflow tract obstruction.

What is the Rastelli operation?

It Costs DeArmAnd A Lung

200

The second stage of empyema development

What is fibrinopurulent

Exudative --> fibrinopurulent --> organizing

400

This is the pulmonary venous drainage of an extra lobar sequestration.

What is the azygos or hemiazygos system?  (IVC, portal vein, subclavian vein also acceptable).