Cardiac surgery chapter 34

Aneurysm

A weakness in the atrial wall resulting in ballooning of the artery and possible rupture.

Apex

The lower left tip of the left ventricle of the heart; also the rounded upper portion of each lung

Arrhythmia

An abnormal heartbeat (also called dysrhythmia)

Arteriosclerosis

A disease characterized by loss of elasticity and hardening of the arterial walls.

Atherosclerosis

A disease characterized by the build up of cholesterol deposits in the arterial lining

Bradycardia

A slow heart rate (under 60bpm in adults)

Cardiac cycle

The pumping action of the heart from one beat to the next

Cardioplegia

Intentional stopping of the heart during cardiac surgery achieved with a cardioplegic solution.

Cardioplegic solution

A mixture of potassium chloride,lidocaine, dextrose, insulin,albumin,tromethamine, and Plasmanate.

Coarctation

A narrowing or stricture in the descending thoracic aorta

Congenital

A condition present at birth

Cross-clamp

To place a clamp across a structure to occlude it

Diastole

Phase of cardiac cycle when the ventricles contract

Endovascularrepair

Endoscopic surgery of the vascular system

Fibrillation

Uncoordinated muscular activity in the heart muscle, which results in a "quivering" rather than pumping action.

Fusiform aneurysm

A type of aneurysm that involves the entire circumference of a blood vessel.

Heart-lung machine

Medical device uses during cardiac bypass. Systemic blood is shunted out the body via cannulas, which are implanted in the heart.

Infarction

Necrosis and death of tissue related to obstruction of blood flow.

Ischemia

Reduced blood supply to tissue, may be a result of obstruction within the blood vessels or external pressure, which acts as a tourniquet

Off-pump procedure

A procedure performed without a cardiopulmonary bypass (i.e., "the pump")

Pacemaker

A device that stimulates the heart muscle to contract

Preclotting

The process of soaking a graft or patch of synthetic graft material in the patients blood or plasma before insertion

Saccular aneurysm

A type of aneurysm in which a saclike formation with a narrow neck projects from the side of the artery

Shunt

To bypass a structure or carry fluid from one anatomical location to another

Stenosis

The narrowing of a hollow structure such as a blood vessel or duct

Sternotomy

An incision made into the sternum

Systole

Phase of cardiac cycle in which the atria contract

Tachycardia

A fast heart rate (over 120 bpm in adults)

Thoracotomy

An incision made into the thoracic cavity

Thoracic cavity

Contains the heart and its great vessels, the lungs and their associated respiratory structures, the mediastinum, and a portion of the esophagus.

Right atrium and left atrium

The two upper chambers of the heart

Right ventricle and left ventricle

The two lower chambers of the heart

Mediastinum, lungs, sternum, anterior

The heart is contained within the ______, between the two ______, posterior to the _____, and ____ to the vertebrae and esophagus.

Pericardium

The heart is enclosed by a double-layered membrane called

Pericardial fluid

Between the outer parietal and inner visceral pericardium; lubricates the layers and prevents friction.

Median sternotomy

Mid line incision used for surgical procedures of the heart and great vessels in the thoracic cavity

Cardiopulmonary bypass

Diverts blood away from the heart and lungs for surgery to be performed

Sump catheterization

Inserted into the left ventricle soon after cardiopulmonary bypass has been established to suction blood and air and maintain cardiac decompression to reduce the risk of air embolism in the systemic circulation

Infusion of a cardioplegic solution

Solution used to stop the heart which reduces the energy required by the cardiac muscle by eliminating the energy requirements for contraction

Coronary artery bypass grafting

Performed to improve circulation to the heart; autograft is usually used CAB, CABG

Transmyocardial revascularization

Goal is to increase blood flow to the heart in patients in whom bypass surgery or medical management is not feasible TMR

Resection of a left ventricular aneurysm

Reduces the risk of rupture and embolism of left ventricle

Aortic valve replacement

Involves the replacement of a diseased valve

Mitral valve repair and replacement

A diseased mitral valve is replaced to open a constricted valve (stenosis) or to prevent blood from regurgitating into the left atrium,; valve repaired with Annuloplasty
MVRR

Mitral commissurotomy

Opening of commissures that being cusps of valve together

Resection of an aneurysm of the ascending aorta

Goal is to repair the aneurysm and restore function to the valve AA

Resection of an aneurysm of the descending aorta

To prevent rupture and life-threatening hemorrhage DTAA

Endovascular repair of a thoracic aneurysm

Frequently used for treatment of DTAA. TAG device used. Performed on pts with fusiform-type aneurysm which are at least double the normal size of the aorta

Insertion of artificial pacemaker

Artificial pacemaker inserted into body to correct cardiac arrhythmia caused by disease of the conduction system

Replacement of a pacemaker battery

A malfunctioning pacemaker generator is replaced to produce continuous pacing

Implantable cardioverter-defibrillator

An electronic cardiac defibrillating and monitoring device used in patients susceptible to ventricular fibrillation or ventricular tachycardia (ICD)

Surgery for atrial fibrillation

Cardiac ablasion is the selective deconstruction of diseased conductive tissue to correct atrial fibrillation

Atrial fibrillation

An abnormal heart rhythm;pooling of blood in the atria

Pericardial window

The removal of accumulated blood or fluid in the pericardium through the creation of a

Pericardiectomy

Removal of the adherent scar tissue of the pericardium, improves cardiac function

Insertion and removal of an Intraaortic balloon catheter

The balloon increases the supply of oxygen to the heart by increasing coronary blood flow during diastole and provides distal perfusion of body's organs

Ventricular assist device

Used to wean patients from cardiopulmonary bypass when other means are ineffective VAD

Heart transplantation

To replace a diseased heart with a healthy donor heart

Myocardium

Specialized muscle tissue (cardiac muscle) capable of generating electrical impulses, which cause the heart to contract

Conduction system

Contains a network of specialized cells which generate electrical activity along conduction pathways

Sinoatrial SA node

Initiates the cardiac cycle and is sometimes called the hearts pacemaker

Interatrial septum

Impulses travel from the SA node to the AV node in the

Cardiac function tests
(CFTs)

May require sophisticated imaging techniques, injection of radionuclide, and physical stress tests

Cardiac catheterization

An interventional radiology procedure that involves insertion of cardiac catheter into the heart chambers and large vessels via a peripheral artery or vein

Left heart catheterization

Performed to asses the coronary arteries, systemic vascular resistance, aortic and mitral valve function and left ventricular pressure

Right heart catheterization

Performed to assess the right atrium and ventricle and the pulmonary artery.

Pulmonary occlusion pressure (POAP)

A significant test that determines cardiac volume output

Median sternotomy (supine)

A partial or full mid line incision is made through the sternum

Paramedian (supine)

Incision made to the right or left of the sternum. Used for minimally invasive procedures and lymph node biopsy.

Anterolateral, posterolateral

Modification of the lateral position,patient supine with soft padding under hip and shoulder of affected side which is then abducted and the arm suspended on overhead table brace.

Minithoracotomy

2-inch (5cm) right or left incision made between the ribs for access during minimally invasive and robotic procedures

Minithoracotomy

2-inch (5cm) right or left made between the ribs for access during minimally invasive and robotic proceduresprocedures

Rumel tourniquet

A short length of synthetic tubing either commercially prepared or cut from a straight (Robinson) urinary catheter.

Stylet

Used to snare the strands of suture or tape and bring them through the lumen of the tubing.

Venous cannula

Straight-ended with multiple holes in distal tip; used to shunt blood from the heart

Aortic cannula

Straight or angled tip to direct the blood toward the descending thoracic aorta; carries oxygenated (arterial) blood

Femoral arterial cannula

Carries oxygenated (arterial) blood; tapered to match the size of the artery, beveled end to allow for easier insertion

Coronary antegrade perfusion cannula

Cuff near tip; used to infuse cardioplegic solution directly into the heart

Left ventricular sump (vent) catheter

Drains air and blood within the heart and prevents the accumulation of blood

Right superior pulmonary (vent) catheter

Drains air and blood within the heart and prevents the accumulation of blood.

Basilic vein

Which of the following do/does not ultimately drain into the IVC inferior vena cava

Myocardia

Heart muscle is called

SA node- AV node- AV bundle-purkinje fibers

The correct sequence of parts that function to carry cardiac impulses

cardiac output

the product of the stroke volume and the heart rate is known as

oxygen and food from placenta to fetus

the umbilical vein carries or passes

more / out of

at the arterial end of a capillary blood pressure is _____ than osmotic pressure, and fluid flows ____ the capillary

T wave

what portion of ECG indicates ventricular repolarization

increased heart rate

you are not an athlete and you are not physically fit. If you suddenly partake in physical exercise the increased demands of such vigorous exercise on your body are met primarily by

Aorta

blood exits the left ventricle in which of the following blood vessels

Middle tunica is thin

Compared to an artery the walls of a vein differs

ductus arteriosus

During fetal existence, the ____ connects the pulmonary trunk to the aorta, allowing blood to bypass the fetal lungs

Lymphatic system

Regarding homeostatic relationships between the cardiovascular system and other body systems, which of the following picks up leaked fluid and plasma proteins and returns them to the cardiovascular system

Circle of willis

What unique feature connects the anterior and posterior blood supplies of the brain, providing more than one route for blood to reach brain tissue in a given area

Semilunar valves close

Which of the following is not true during ventricular systole

Stimulation of vagus nerve

Which of the following would cause an increase in the heart rate

A decrease in venous return

Which of the following would not lead to an increase in cardiac output

Pulmonary veins

Which of the following blood vessels carry oxygen rich blood

Visceral pericardium

layer of the heart that is continuous with the epicardium

Cardiac tamponade

Compression of heart due to blood or fluid in the pericardium

Ventricular angiograph

This test shows movement of blood through valves

False (semilunar valve)

When ventricles contract the AV valves open

Ventricular tachycardia

1% lidocaine is used to treat

apex

area of the heart that is distal to the patients head

Vague nerve

What cranial nerve increases heart rate

Secular and fusiform

Name two types of aneurysm

hypothermia

Protects heart during cardiac surgery

intrarventricular septum

Contains the circle of willis

Atrial fibrillation

Heart rate of 240-450 bpm

14 gauge needle

Used to remove air out of a vessel

Chordae tendinae

Which of the following is involved in anchoring the AV valve flaps to the walls of the ventricle

Chordae tendinae

Which of the following is involved in anchoring the AV valve flaps to the walls of the ventricle

Chordae tendinae

Which of the following is involved in anchoring the AV valve flaps to the walls of the ventricle