mitral → systolic

aortic → diastolic

mitral → diastolic

aortic → systolic

1. Pump
2. Oxygenator

1. Take the blood from the vein → venous canulla into right (atrium) appendix or 2 canula into SVC + IVC or into Internal jugular vein
2. blood → venous resorvoir

3. resorvoir → main pump → into heat exchanger

‣

💬

4. heat exchanger → oxygenator
5. oxygenator → aortic canula: usually into desc. aorta or femoral, axillary, common carotid

• sucker → suck out blood from operation field → into resorvoir
• vent → theres still blood from the lungs go to the left ventricle → blood accumulates there → distension → needs to be sucked out → into resorvoir
• cardioplegia →to protect from ischemia → slow down metabolism → cool down + cardioplegia solution (stop the heart)→ canula into asc. aorta → push solution → aortic valve will close → solution into coronary arteries (⚠️alert: in aortic stenosis solution will go into ventricle → open aorta + operate valve; when also coronary stenosis → canula directly into coronary sinus (veins)=retrograde cardioplegia)
‣
💬
Cardioplegia solution:

heparin (nice monitoring → aPTT, and reversible→protamin)

at beginning of surgery → Hemodilution to let the blood flow freely into tubes

• stop cardioplegia solution + declamp aorta → washes out cardioplegic solution → starts by itself
• artificial pace-maker
• defibrillator if fibrillation happens

DVT

Virchow Triad → endothelial lesion, stasis, hypercoagulability

• venous stasis:
• hypercoagulable state
• immobilization
• trauma/surgery
• pregnancy + oral contraceptives
• malignancies

1. massive pulmonary E
2. acute pulmonary infarction
3. PE without infarction
4. repetetive pumonary embolism → pulmonary HT

• Dyspnea
• Hypoxia
• Pain

• shock: ↓BP, periph vasocon., ↑HR, ↑RR

→ pallor, sweating, oliguria

• S3 = ri. ventricular gallop (RVF)

‣

💬

• palpable impulse at left 2nd ICS (RVF → shift of PMI)

‣

💬

• systolic murmor in inspiration at left sternal margins (triscupid regurgitation)

• hemodynamic parameters
• degree of cardiac damage
• degreee of prev. Cardio-pulmo. damage
• location of obstruction

acute: embolus too small to cause shock or pulmonary HT → but enough to block significant parts of the lung → necosis → inflammation → pleural involvement

• pleuritic pain (=increases at inspiration) → ↓movement of the hemothorax + pleural friction + signs of pleural effusion,
• dyspnea
• hemoptysis

repetetive small embolus (see point 4.) into lungs → no symptoms but closure of a lot of pulmonary arteries → ↑pumonary resistance → pulmonary HT

hypertrophic right ventricle → dilates after time (cant compensate anymore) → chronic right heart failure:

• jugular distension
• palpable impulse at left 2nd ICS (RVF → shift of PMI)
• systolic murmor (triscuspid regurgitation)
• ascitis + hepatomegaly
• lower limb edema

• MI (troponin, ECG)
• Chronic heart failure + acute pulmonary edema
• Aortic + Mitral stenosis
• pericarditis + temponade
• Dilated cardiomyopathy
• ARDS (acute respiratory distress syndrome)
• Other forms of shock (DD with massive emboli)

Wells score 📷 + Revised Geneva Score 📷

(dont study the scores for the exam)

• pulmonary Angiography #gold-standard
• AngioCT
• ECG
• Doppler US→ Detection DVT
• Echocardiography (not for dg just to check heart)
• Xray
• Scintigraphy (tells perfusion at the level of lungs)

• Anticoagulant → Heparin (unfractionated or LMWH) → bolus + perfusion; Rivaroxaban, Warfarin (long-term) → give heparin for 3month + correct risk factors; if cant correct → for life
• Thrombolytics → if hemodynamically unstable + Ø bleeding risk; and if high risk patient (see score) without hypotension with low risk for bleeding

Caval filters 📷(filter into IVC → block embolus) → indication: DVT with contraindication to anticoagulants, after massive PE (survived but another episode will be fatal), recurrent pulmonary embolism

inflammation pericardium with edema/exudate inside

Parietal layer + visceral layer (epicardium) 📷

in between lubrification liquid

📷

visceral + parietal layer become thick → fibrosis → calcification (panzerherz) 📷 📷

• idiopathic (most common)
• viral or infective pericarditis
• TBC
• truama
• Connective tissue disease
• post-radiation

hypodyastolic cardiac insufficiency

→ hepatic insufficiency

→ renal insufficency

→ venous insufficiency

• slow progression
• fatigue (lower blood volume ejected into circulation)
• congestion:
• dyspnea
• dilated jugular v
• hepatomegaly + ascitis + icterus
• edema lower limbs

• Xray → eggshell appearance if calcification
• Echocardiography → pericardial thickening + dilation IVC
• CT + MRI
• Lab: ESR, liver function

• symptomatic - medical

• curative surgery: subtotal pericardectomy

‣

💬

• Degenerative calcification 📷
• bicuspid aortic valve (congenital) 📷
• Rheumatism (acute rheumatic fever) 📷

• LV hypertrophy
• low cardiac flow

when effort:

• angina
• dyspnea
• syncope
• death

• pulsus parvus et tardus 📷
• systolic ejection murmor
• diminished BP in systoly

• ECG → LV hypertrophy
• Ecocardiography #most important
• xray → calcification
• coronarography → for planning of surgery (most of patient are old and often have coronary diseases)

depends on valvular lesions, specific symptoms, ventricle function, comorbities

• symptomatic = surgery
• asymptomatic with severe stenosis + ventricular dysfunction/ventricular tachycardia/hypertrophy(>15mm septum), orrifice <0.6cm2) = surgery
• moderate stensosis, in patient which also receive operation on asc. aorta or coronary artery = surgery

replacement aortic valve (Øpossible to repair)

→ under CPB

→ open aorta → replace valve with mechanical/biological valve (with stent or stent-less)📷

Mechanical: Østrucural defect, but anticoagulant for indefinite time

Biological: Øanticoagulation, but ↑rate of structural defects (over time)

Aortic valve cant close properly → backflow during diastole from aorta to ventricle → ↑blood volume in ventricle

• endocarditis
• Rheumatism
• Aortic dilation: dissection or collagen diseases
• trauma

• Inflammatory disease
• Bicuspide aortic valve

• endocarditis (i.e. due to rheumatic fever)
• aortic dissection
• trauma

• ventricle is not adapted to that much volume
• ↑hypoxia of coronaries

• hypertrophy of ventricle → dilation → mitral insuff → pulmonary congestion (esp when complicated)

• angina
• dyspnea (effort)
• asthenia

• ↑pulse pressure (↓diastolic)

‣

💬

• diastolic murmor 4th ICS

• ECG → LV hypertrophy
• Ecocardiography #MVP→ valvular modification
• Doppler → regurgitation
• Xray → dilated heart + asc. aorta
• CT + MRI

• Endocarditis prophylaxis
• Vasodilators + ACE inhibitors ⇒ ↓after-load

• symptomatic with severe. aortic insufficience + EF>60(normal)
• severe aortic insuff + normal EF, but progressive ventricular dialtion
• symptomatic/ asymptomatic dysfunction of LV

1. Reconstruction 📷
2. Replacement: Mechanical/biological valve 📷

via sternotomy

1. Thromboembolism - esp with mechanical valve → anticoagulation
2. Thrombotic blocking of mechnaical valve
3. Hemorrhage
4. Valve
1. Endocarditis on valve prothesis
2. Valvular dysfunction
3. Hemolysis

Endocarditis is a life-threatening inflammation of the inner lining of your heart's chambers and valves (endocardium). Might be associated with splenic vein thrombosis (palpate spleen)

inflammatory vegetations at the valves

T

1. early(<2m): high mortality, dysfunction of prosthesis → AB broad spec (Vancomycin+Rifampicin + Gentamicine)
2. Late (>2m): sub-acute

arteriosclerosis

Smoking

high cholesterol

diabetes

obesity

MI (due low blood flow → obstruction)

1. Angina pectoralis → stable (pain with effort) or instable (at rest)
2. MI
3. Sudden death

• acute pericarditis
• myocarditis
• valve diseases
• Aortic dissection
• PE
• GI causes (hiatal hernia, GERD, cholecystic, acute pancreatits)
• pneumothorax

• Effort test
• Coronary angiography 📷 → stenosis + obstruction, also Left ventricle function (hypo-,dys- or akinesia) + collaterals
• intravascular US
• Intracoronary doppler
• ECG only modified in MI

• reduction of risk factors: stop smoking, Hypertensive drugs, Statins, exercise, diet

Anti-platelets:

→ Aspirin

BP lowering:

→ Nitrates

→ Beta-blockers

→ ACE inhibitors

→ Ca channel blocker

Cholesterol lowering:

→ Statins

• Percutaneous transluminal coronary angioplasty (PTCA) →balloon📷
• Coronary STENT #MVP 📷
• Aterectomy (i.e. Rotablation) 📷
• Laser angioplasty 📷

1. Aorto-coronary bypass(ACB) with CPB #classic+MVP → take Left internal mammary a. as a graft 📷

Less invasive:

1. ACB off pump (without CPB) 📷

2. Minimal invasiv ACB (MIDCAB)

‣

💬

3. Closed thorax bypass with ZEUS (port access CABG) 📷

4. Transmyocardial laser revascularization 📷

• #1 Left Internal mammary artery (aka internal thoracic)
• Right internal mammary artery
• internal Saphenous vein

• alternative: radial artery, external saphenous v

after 1y already 20% thrombosed

25% after 5y

50% after 10y

use both internal mammillary artery + gastroepiploic

(=modern shit + Øreally freq. used)

🐙 Octopus(sy) 📷

heart not stopped → no complications like with CPB

but anastomotic technique is not so perfect like with CPB → thats why you use octopus

• MI (rare after CPB)
• Stroke
• acute renal insuff
• infection
• etc

the 4 most imporant are:

• aneurysm
• mitral insuff
• VSD (Ventricular-Septal defect)
• free rupture left ventricle

⇒ see later❗

1. Without Shunt
1. valve malformation
2. coarctation aorta
2. Left-to-right shunt
• PDA
‣
💬

1. SD
• ASD (atrial septal defect)
• VSD (ventricular septal defect)
• AVSD (atrio-ventricular septal defect)
• aorto pulmonary window
‣
💬

3. Right-to-left shunt
1. truncus arteriosus
2. TGA
3. TOF
4. Pulmonary atresia +- septal defect
5. triscupid atresia
6. total anomalous pulmonary drainage
7. Hypoplastic left heart syndrome
‣
💬
‣
💬

‣
💬

‣
💬

‣
💬

‣
💬

‣
💬

xray

ECG

echography

MRI + CT with catheterization

endocarditis

RV hypertrophy + pulmonary HT 📷 → cyanosis + hypoxemia

• reactive polycythemia, hyperviscosity + coagulopathy
• thrombosis
• mental + physical growth impairment
• death ( due to hypercyanotic episodes aka "hypoxic spell")

Septal defect (AVSD/VSD) → Left-to-right shunt → pulmonary HT → right ventricle hypertrophy → reversing of shunt: right-to-left-shunt → pulmonary circulation is "skipped" → hypoxia

Heart-Lung transplant

percutaneous (less complications+no scarrs, +ØCBP)

or surgical