The Manual of Clinical Perfusion
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| Who performed the first artificial valve replacement in 1952? | Charles Hufnagel
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| What type of valve was the one developed by Albert Star and Lowell Edwards? | a ball and cage valve
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| When was the Starr-Edwards ball and cage valve used successfully? | 1960
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| What two types are today's valves? | Mechanical and bioprosthetic
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| What two designs are mechanical valves? | tilting disk valves and double tilting half-disk (bileaflet)
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| What is the life expectancy of mechanical valves? | Greater than 20 years
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| While a longer life span is an advantage of mechanical valves, what is a marked disadvantage? | Mechanical valves require anti-coagulation medication
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| What is a coumadin and how does is work | coumadin (Warfarin) is a vitamin K antagonist and interferes with the production of vitamin K dependent factors
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| What are the vitamin K dependent factors? | 2, 7, 9, and 10
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| What two types of bioprosthetic valves are available? | Animal, usually porcine (heterographs)
Human (homografts)
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| What percentage of patients will require a new homograft within 15 years? | 10-20%
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| What is a common complication seen with valves? | Infection
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| What is the most accurate method to evaluate cardiac valvular function? | Measure pressure gradients across the valve
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| What type of pressure is seen with mitral stenosis? | High atrial pressure with slow fall early in diastole
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| What type of pressure is seen with tricuspid stenosis? | High atrial pressure with slow fall early in diastole
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| What type of pressure is seen with mitral insufficiency? | Atrial systolic increases during ventricular systole
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| What type of pressure is seen with tricuspid insuffiency? | Atrial systolic increases during ventricular systole
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| What type of pressure is seen with aortic stenosis? | A slow-rising aortic pulse pressure
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| What type of pressure is seen with aortic insufficiency? | A collapsing aortic diastolic pressure
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| Aortic valve area | 2.6-3.5 sq cm
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| Aortic valve flow | 250ml/SEP/sec
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| Mitral area | 4-6 sq cm
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| Mitral valve flow | 150/DFP/sec
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| What is a common cause of mitral stenosis? | rheumatic fever
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| When would a replacement occur over a commissurotomy for MV stenosis? | If the leaflets are calcified and the valve not pliable
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| What effects does mitral insufficiency have on the LV? | LV dilatation and hypertrophy
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| What is the correction for MV prolapse? | annuloplasty
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| What is the common congenital cause of AV stenosis? | bicuspid valve
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| LA enlargement, diminished compliance, dyspnea, CHF, and right sided heart failure result from mitral stenosis or insufficiency? | MV stenosis
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| An overworked left ventricle, lower output, lung congestion, diminished pulses and murmur is found in aortic or mitral stenosis? | AV stenosis
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| Cannulation strategy for MV surgery | bicaval
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| Cannulation strategy for AV surgery | two-stage
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| What special cardioplegia considerations occur during AV surgery? | once the aorta is opened, retrograde or ostial must be given
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| What are the three leaflets of the tricuspid? | anterior, posterior and septal
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| Which tricuspid leaflet is the largest? | anterior
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| Which tricuspid leaflet is the smallest? | posterior
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| What valve failure can cause subsequent tricuspid insufficiency? | MV disease, leading to increased right heart pressures
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| What cannulation strategy is used when opening the right atrium? | Bicaval
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| What is the source of the three cusps of the pulmonic valve? | the lining of the PA
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| Left heart failure, MV obstruction, and pulmonary vascular disease can lead to what pathophysiology of the PV? | pulmonic regurgitation
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| What is associated with pulmonic regurgitation in newborns? | A VSD
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