CSC Cardiac Surgery Sample 3 — Questions and Answers
Question 1: A patient undergoing cardiac surgery develops diffuse microvascular bleeding refractory to FFP and platelets. Thromboelastography (TEG) shows a long clot formation time and low maximum amplitude. What agent should be administered?
- Protamine
- Tranexamic acid
- Cryoprecipitate (Correct answer)
- Vitamin K
Correct answer: Cryoprecipitate
Low maximum amplitude on TEG indicates platelet dysfunction or fibrinogen deficiency; cryoprecipitate provides concentrated fibrinogen and factor VIII to address this specific coagulopathy.
Question 2: During a Bentall procedure, what are the three components that are replaced?
- Aortic valve, ascending aorta, and aortic arch
- Aortic valve, ascending aorta, and coronary ostia reimplantation (Correct answer)
- Aortic root, coronary arteries, and descending aorta
- Mitral valve, ascending aorta, and coronary arteries
Correct answer: Aortic valve, ascending aorta, and coronary ostia reimplantation
The Bentall procedure replaces the aortic root and ascending aorta with a composite graft containing a prosthetic valve, with reimplantation of the coronary ostia as buttons.
Question 3: What is the target activated clotting time (ACT) during full cardiopulmonary bypass?
- >200 seconds
- >300 seconds
- >400 seconds (Correct answer)
- >500 seconds
Correct answer: >400 seconds
An ACT greater than 400–480 seconds is required during full CPB to prevent clotting within the bypass circuit and ensure adequate anticoagulation.
Question 4: Which repair technique for hypertrophic obstructive cardiomyopathy (HOCM) involves resecting basal septal muscle?
- Ross procedure
- Morrow myectomy (Correct answer)
- Konno procedure
- Dor procedure
Correct answer: Morrow myectomy
The Morrow (septal) myectomy involves surgical resection of hypertrophied basal septal muscle through the aortic valve to relieve left ventricular outflow tract obstruction.
Question 5: Following coronary artery bypass surgery, a patient develops low cardiac output with a pulmonary artery wedge pressure of 22 mmHg and SVR of 1,800 dyn·s·cm⁻⁵. What is the most appropriate initial management?
- Volume resuscitation
- Intra-aortic balloon pump insertion (Correct answer)
- Vasopressor therapy
- Emergent re-exploration
Correct answer: Intra-aortic balloon pump insertion
An IABP reduces afterload and augments diastolic coronary perfusion pressure, making it the preferred mechanical support for post-bypass low cardiac output with elevated filling pressures and SVR.
Question 6: What is the primary physiologic benefit of antegrade cerebral perfusion during deep hypothermic circulatory arrest?
- It reduces systemic cooling requirements
- It provides continuous metabolic substrate delivery to the brain (Correct answer)
- It prevents air embolism
- It maintains renal perfusion
Correct answer: It provides continuous metabolic substrate delivery to the brain
Antegrade cerebral perfusion via the carotid or axillary artery delivers oxygenated blood continuously to the brain, extending the safe circulatory arrest time beyond the limits of hypothermia alone.
Question 7: Which suture technique is associated with the lowest risk of perivalvular leak in aortic valve replacement?
- Simple interrupted sutures
- Figure-of-eight sutures
- Horizontal mattress sutures with pledgets (Correct answer)
- Continuous running suture
Correct answer: Horizontal mattress sutures with pledgets
Horizontal mattress sutures buttressed with Teflon pledgets distribute tension and improve tissue sealing at the annulus, reducing the incidence of perivalvular leakage.
CSC Cardiac Surgery Sample 3
A patient undergoing cardiac surgery develops diffuse microvascular bleeding refractory to FFP and platelets.
Thromboelastography (TEG) shows a long clot formation time and low maximum amplitude.
What agent should be administered?