Plegmasia alba & cerulea dolens
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Phlegmasia alba dolens is a painful white edema or "milk leg" condition first described in pregnant and postpartum women caused by a total occlusion of the deep iliofemoral venous system with an open superficial venous system, resulting in edema, pain, and blanching without cyanosis. Phlegmasia cerulea dolens is a more severe condition where both the deep and superficial venous systems are occluded, leading to fluid sequestration, significant edema, agonizing pain, cyanosis, bullae formation, compartment syndrome, and acute ischemia. Both conditions are types of deep vein thrombosis.
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3. Myocardial protection techniques like cardioplegic arrest and hypothermia are used during CPB to protect the heart from ischemic damage while it is stopped.
Cyanotic chd
This document discusses several types of cyanotic congenital heart disease, including tetralogy of Fallot, transposition of the great arteries, total anomalous pulmonary venous connection, and Eisenmenger syndrome. It provides details on the pathophysiology, clinical presentation, diagnostic workup, and surgical treatment options for each condition. The standard of care has shifted from palliative procedures to complete anatomical repairs performed earlier in life to improve long-term outcomes.
Chd essentials
This document discusses congenital heart disease (CHD), which are abnormalities in heart structure present from birth. CHDs arise during gestation and are the most common birth defect. While many CHDs cause increased blood flow to the lungs, some cause obstruction of blood flow. CHDs are classified as cyanotic if they involve deoxygenated blood in the arteries, or acyanotic. Common acyanotic defects include patent ductus arteriosus, atrial septal defect, and ventricular septal defect. Tetralogy of Fallot is a common cyanotic defect involving a right-to-left shunt.
CAD & CABG
1. Coronary artery disease is caused by atherosclerosis developing in three stages, culminating in plaque rupture and thrombosis.
2. Risk factors for atherosclerosis and CAD include smoking, hyperlipidemia, hypertension, diabetes, male gender, increasing age, and family history.
3. Acute coronary syndromes include unstable angina, NSTEMI, and STEMI, differentiated by cardiac enzymes and ECG changes. High-risk patients with ongoing symptoms should receive urgent angiography and revascularization.
Aortic stenosis and aortic valve replasement
This document discusses aortic stenosis and aortic valve replacement. It begins by describing the causes of aortic stenosis as either congenital or acquired. For treatment, it discusses the guidelines for aortic valve replacement and compares mechanical versus biological prosthetic valves. The key surgical approaches are also summarized, including conventional surgery, Ross procedure, homografts, and newer transcatheter aortic valve implantation procedures. Overall, the document provides an overview of aortic stenosis and the current options for surgical and non-surgical management.
Mitral valve disease
The document discusses mitral regurgitation (MR), including its natural history, pathophysiology, classification, causes, symptoms, signs, quantification via echocardiography, and indications for mitral valve surgery. It notes that asymptomatic patients with MR can have a long latent period before symptoms develop. Severe MR is classified based on criteria such as jet area, regurgitant volume, and effective regurgitant orifice area. Etiologies include myxomatous degeneration, rheumatic fever, and ischemic cardiomyopathy. Evaluation involves assessing left atrial and ventricular size and function along with MR severity. Surgery is indicated for severe, symptomatic MR or asymptomatic patients with good ventricular function and a high likelihood of
Aneurysms & dissections
This document discusses aneurysms and dissections of the thoracic aorta. It begins by describing the anatomical layers of the thoracic aorta and then defines different types of aneurysms including true aneurysms, false aneurysms, fusiform aneurysms, saccular aneurysms, and dissecting aneurysms. It discusses causes, symptoms, natural history, risk factors, and investigations for thoracic aortic aneurysms. It also describes specific conditions like Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome that are associated with aortic aneurysms. The principles and indications for surgery to treat thoracic aortic aneurysms are outlined.
Mechanical circulatory support
This document discusses mechanical circulatory support devices (MCSDs) and artificial hearts. It begins by explaining heart failure and its stages. It then describes various types of temporary and permanent MCSDs, including their goals, energy sources, blood flow characteristics, and implantation methods. Examples of specific MCSDs are provided like the IABP, ECMO, Impella, TandemHeart, HeartMate XVE, HeartMate II, HeartWare, Jarvik 2000, and total artificial hearts from SynCardia and Carmat. Major complications of MCSDs and artificial hearts discussed are bleeding, infection, and thrombosis.
Acyanotic chd
This document provides information on congenital heart disease. It discusses various types of acyanotic heart defects including atrial septal defects (ASD), ventricular septal defects (VSD), patent ductus arteriosus (PDA), and coarctation of the aorta (CoA). For each condition, it describes the pathophysiology, clinical presentation, diagnostic evaluation, and treatment options including surgical repair. Common anatomical variations are defined for different subtypes of each condition.
Varicose disease varicosity
This document discusses varicose veins and their treatment. It begins by describing the anatomy and physiology of the venous system, including the roles of superficial, perforator, and deep veins as well as venous valves and the venous pump. It then discusses varicose veins specifically, including risk factors, classifications, and complications. Clinical features of varicose veins are outlined. The pathophysiology of varicose veins involves valve incompetence and chronic venous hypertension. Investigative tests for varicose veins are described. Surgical and non-surgical treatment options are presented.
Covid 19 & cardiac surgery
Cardiac surgery departments and providers face significant challenges in treating patients during the COVID-19 pandemic. Patients undergoing cardiac surgery are often older with pre-existing health conditions, putting them at high risk for severe COVID-19 infections before and after procedures. While emergency cardiac surgeries and interventions should continue following strict safety protocols, elective procedures may need to be postponed to avoid risks to patients and conserve critical care resources that may be needed to treat COVID-19 patients. Cardiac surgery teams also need to take precautions to avoid exposure given the risk of working with intubated COVID-19 patients. The long term impacts of the pandemic on cardiac surgery capabilities and the healthcare system remain uncertain.
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