Adult Cardiac 5

A 62-year-old man with a PMH of coronary artery disease (CAD) and hypertension (HTN) is referred for coronary artery bypass grafting (CABG). On work-up, the patient endorses a history of occassional racing heart rate and palpitations that lasts for 2-3 days. You decide to have a loop recorder implanted for further work-up which reveals a period of atrial fibrillation lasting 4 days and another for 3 days. In addition to a CABG, you decide to perform a pulmonary vein isolation (PVI). What is the expected success rate of freedom from AF after 12 months?

A 58-year-old man with a past medical history of persistent atrial fibrillation (AF) and hypertension is scheduled to undergo a MAZE procedure to correct his AF. During the procedure, it is important that the surgeon performs which of the following?

A 67-year-old man with a past medical history of coronary artery disease, hypertension, and diabetes undergoes three-vessel coronary artery bypass grafting. On post-operative day two, his telemetry strip displays an irregularly irregular rhythm. If this arrhythmia remains at the time of discharge and he does not receive anti-coagulation, what is his annual risk of stroke?

A cardiologist refers a patient to you for aortic and mitral valve replacement and two vessel bypass –OM2 and RCA. You evaluate the patient and review his echocardiogram and find that he does need to have his aortic valve replaced but you feel confident of repairing his mitral valve. Upon reviewing his cath, you agree that he will need a two vessel bypass. You schedule him for surgery. On the day of surgery your operative strategy is:

A cardiologist refers a patient to you for aortic and mitral valve replacement and two vessel bypass –OM2 and RCA. You evaluate the patient and review his echocardiogram and find that he does need to have both his aortic and mitral valve replaced. Upon review of his cath, you agree that he will need a two vessel bypass. You schedule him for surgery. On the day of the surgery your operative strategy is:

A 40 year old IV drug user is referred to your office with tricuspid endocarditis resulting in severe TR and pulmonary abscess. She is still actively using IV narcotics. Appropriate recommendations include all of the following except:

A 48 year old woman is referred to your office with peripheral edema, JVD, and hepatomegaly. Echocardiography shows a diffusely thickened and regurgitant tricuspid valve with fused chordae. Laboratory analysis is unremarkable except for an elevated 5-hydroxytraptamine level. What is the appropriate diagnosis and treatment:

Which of the following tricuspid prostheses precludes the placement of a transvenous ventricular pacemaker?

When replacing a tricuspid valve with a biological or mechanical prosthesis, heart block can be avoided by:

After tricuspid valve excision for tricuspid endocarditis, the most common cause of mortality is:

The borders of the Triangle of Koch include all of the following except:

During tricuspid valve repair or replacement, collateral damage can be caused to all of the surrounding structures except:

Which of the following patients has an indication for tricuspid valve surgery?

All of the following are causes of organic tricuspid regurgitation except:

An 82 year old male presents with new onset shortness of breath. Echocardiography shows thickened mitral and tricuspid valves, both of which have severe regurgitation. The leaflets were described as pliable, with restricted mobility of the leaflet tips, resulting in doming and a “hockey-stick” appearance in diastole. Appropriate treatment includes:

A 52-year-old woman with a long-standing mitral regurgitation presents for elective mitral valve repair. Upon inspection there is excessive, thickened posterior leaflet tissue and the annulus is dilated and calcified. A quadrangular resection of the posterior leaflet and ring annuloplasty is performed however, after separating from CPB the patient is unstable and intra-operative TEE demonstrates systolic anterior motion of the anterior leaflet, with left ventricular outflow tract obstruction and mitral regurgitation. Which of the following may have prevented this complication?

Which of the following statements are true regarding minimally invasive mitral valve surgery?

Which of the following mitral valve approaches risks injury to the sinus node artery?

A 72 year-old man undergoes mitral valve replacement for degenerative mitral valve disease as well as CABG x 1 with a saphenous vein graft to the OM1. The valve could not be repaired due to severe calcification of the leaflets. Several minutes after coming off bypass a large amount of dark blood is observed welling up from the posterior pericardium. Which of the following is false regarding this complication?

A 50 year-old man with mitral valve endocarditis and severe MR undergoes mechanical mitral valve replacement. External pacing is required to come off bypass due to complete heart block which persists through the post-operative ICU stay. Which of the following is true?