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Revascularisation CABG vs OMT ECSS – European Coronary Surgery Study CASS – Coronary Artery Surgery Study CABG vs POBA BARI Bypass Angioplasty Revascularization Investigation 1997 RCT n=1829 RITA 1 Randomised Intervention Treatment of Angina ERACI Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease 1996 RCT n=1011 MASS Medicine,…
Drugs Aprotinin (trasylol) – polypeptide – competitive serine protease inhibitor – inhibits plasmin (low conc), and kallikrein (which inhibits XIIa)(high conc). Aminocaproic acid (amicar) – amino acid lysine analogue – Tranexamic acid () – amino acid lysine analogue – binds to lysine receptor sites on plasmin which prevents it from binding to fibrin. Research Mangano…
Non-fiction Academic
CPB strategy Heparin Expose the heart. Check BP/Aorta. Aortic cannulation; check cannula for pressure/flow Atrial cannulation; venous clamp off; on bypass. Lungs off Inspect the heart. Place aortic/retrograde cardioplegia. Reduce pump flow/cross-clamp aorta. Return to normal flow/check line pressure. Begin cardioplegia. Set patient temperature. Release aortic cross-clamp after warm cardioplegia. Be certain six conditions reviewed…
Thermoregulation Input: Peripherally, cutaneous cold receptors (unmyelinated C fibres, thinly-myelinated A-delta) – DRG – to posterolateral tract (Lissauer) for 1 or 2 segments up to 2nd order neurons –> 2ON decussate and travel up spinothalamic tract to ventral posterior lateral thalamus. Processor: hypothalamus; Locus coeruleus, nuclear raphe magnus pons, pre-optic anterior hypothalamus Output: sympathetic, endocrine, behavioural, extra-pyramidal …
Isolated rib fractures Most common chest wall injury (others include sternum and clavicle) Clinical diagnosis mainly. Can use CXR to check for lung injury but may not be able to see fractures/all ribs. Can have underlying lung injury resulting in pneumothorax, haemothorax, pulmonary contusion. Management is mainly pain control – paracetamol/NSAIDS/opioids. Or use epidural, intercostal…
Indications Beat-to-beat monitoring required in patients: on vasoactive drugs (e.g. inotropes) blood pressure control prone to rapid change in condition requiring frequent blood sampling extremely hypotensive or arrythmias pulse contour analysis Method Hydraulic coupling – blood vessel connected with incompressible column of fluid that oscillates with changes in pressure (i.e. hydraulic coupling). Tranduction – converting pressure…
Most common adult congenital lesion. More common in women. Classical Types Ostium Primum – 15%; assoc with Mitral regurg, cleft anterior mitral leaflet. Large. Ostium Secondum – 65%; assoc with Mitral regurg in elderly; isolated Sinus venosus – 15%; superior (right PV and SVC mixing; common) or inferior (rare) type. assoc with p/tAPVC which may…
Methods of Myocardial Protection Myocardium need vs. Surgical demand! Surgeon wants: rapid induction, maintenance and easy reversal of cardiac arrest relaxed heart to allow for mobilization and traction a preferably bloodless and unobscured field sufficient time for adequate correction of cardiac or coronary defects Achieved by: Diastolic arrest + minimal coronary perfusion with blood +…