Aneurysms and Dissections

These flashcards cover key concepts related to aneurysm classifications, management, and complications as discussed in the lecture notes.

What is a pseudoaneurysm?

A pseudoaneurysm has a false lumen.

What is the consequence of a left ventricle aneurysm?

It may lead to pedal edema.

What symptoms can occur with a true left ventricular aneurysm?

Dyspnea and orthopnea can occur.

What does a true ventricular aneurysm show?

It shows a transmural infarct, involving the full thickness of the myocardium.

What can cause a ventricular aneurysm?

Ventricular aneurysm can be caused by papillary muscle rupture.

What is the most likely cause of thoraco-abdominal aneurysm?

Atherosclerosis is the most likely cause.

What does Crawford Aneurysm Classification Type I encompass?

Type I is from the descending aorta to the renal arteries.

What defines Crawford Class Type II?

Type II includes the descending aorta and possibly the ascending aorta past the renal arteries.

What does Crawford Class Type III refer to?

Type III is the thoracic aorta past the renal arteries.

What area does Crawford Class Type IV cover?

Type IV is past the diaphragm and past the renal arteries.

What is Crawford classification used for?

It is used for classification of thoraco-abdominal aneurysms.

What is DeBakey Class Type I?

Type I is from the ascending aorta to at least the arch and possibly down further.

What defines DeBakey Class Type II?

Type II is the ascending aorta only, or proximal.

What characterizes DeBakey Class Type III?

Type III is the descending aorta only, or distal.

What does Stanford Class Type A involve?

Type A involves the ascending aorta.

What does Stanford Class Type B involve?

Type B does not involve the ascending aorta.

How is a dissecting aneurysm defined?

A dissecting aneurysm is a longitudinal, blood-filled split in the lining of the artery.

Where do dissecting aneurysms usually occur?

They usually occur in the aortic arch near the heart.

What are saccular and fusiform aneurysms?

They are balloon-like swellings of the arterial wall.

What is a key characteristic of a fusiform aneurysm?

It has dilation of all three layers of the aortic wall.

What condition can an acute aneurysm mimic?

It can mimic an acute myocardial infarction (MI).

What is the best surgical approach for ascending aortic aneurysm?

A median sternotomy is the best approach.

What composes the tissue in a ventricular aneurysm?

It is composed of thinned myocardium exhibiting paradoxical systolic expansion.

What is the benefit of deep hypothermia in acute Type A aortic dissection?

It best reduces the risk of postoperative organ and neurological deficits.

What happens if you are cannulated femorally with an aortic dissection?

There will be high arterial line pressure and low systemic pressure.

Where is retrograde cerebral perfusion delivered from?

It is delivered via the SVC and blood returns via the carotids to the aorta.

What pressure should be maintained for retrograde cerebral perfusion through the SVC?

Pressure should be 20-25 mmHg and less than 500 cc/min.

Through which arteries does blood return when giving retrograde cerebral perfusion?

Blood returns through the brachiocephalic arteries.

What provides adequate cerebral protection in retrograde cerebral perfusion?

Antegrade Cerebral Perfusion provides adequate protection.

How is Antegrade Cerebral Perfusion delivered?

It is delivered through the LCCA using a balloon-tipped catheter connected to the Y-limb from the arterial CPB line.

What is the primary cause of an AAA?

AAA is caused by atherosclerosis.

What is the target cerebral perfusion pressure?

Cerebral perfusion pressure should be 60-70 mmHg.

What is the MAP threshold for autoregulating cerebral perfusion pressure?

CPP is autoregulated at a MAP of greater than 60 mmHg.

What regulates cerebral blood flow?

CO2 regulates cerebral blood flow.

What changes in pressure indicate an aortic dissection?

Arterial line pressure increase and poor venous return are indications.

What is a characteristic of TAAA (Thoracoabdominal Aneurysm)?

It is characterized by dilation of the aorta within the diaphragmatic hiatus.

What is the upper body position during LHB (Left Heart Bypass)?

The upper body is positioned at a 60-degree angle.

What is the purpose of LHB?

The purpose is to perfuse lower limb extremities and protect the spinal cord.

Which arteries are monitored during left heart bypass?

The left radial, left femoral, and pulmonary artery are monitored.

What should you do if proximal pressure goes down and distal pressure goes up during LHB?

You should decrease the flow.

What action should be taken if proximal pressure goes up and distal pressure goes down during LHB?

You should increase flow or give volume.

What does it mean if both proximal and distal pressures go down during LHB?

Then you should give volume.

What does it indicate if both proximal and distal pressures go up during LHB?

There is vasodilation.

What is the incision site for left heart procedures?

The left heart incision site is the thoracoabdominal incision.

What is an irreversible cause of death from LHB?

Declamping shock is an irreversible cause of death.

What severe complication can occur during repair of thoracic abdominal aneurysm?

Paraplegia is a severe complication from hypoperfusion.