CCTC- Heart Transplant Exam Questions and Answers.

CCTC- Heart Transplant Exam Questions and
Answers
Question 1
what is hepatojugular reflux
Correct Answer
upper R abdomen is compressed for ~ 10 seconds resulting in increase in venous
return to the heart from the liver.

This causes prominent jugular pulses, increased filling of neck veins and this
increase is associated with the inability of the R side of the heart to manage added
volume



Question 2
when should a recipient/donor cross match be completed
Correct Answer
if PRA >10%



Question 3
what is the surgical techniques for heart transplant
Correct Answer
1. median sternotomy
2. biatrial (standard) technique
3.bicaval technique (more commonly used)
4. heterotopic transplantation




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,Question 4
What are the coronary artery vasculopathy grades?
Correct Answer
CAV 0- no detectable lesion
CAV 1- mild- angiographic left main less than 50% or primary artery with maximum
lesion of less than 70% or any branch with lesions less than 70% without allograft
dysfunction

Cav2- moderate- angiographic left main less 50% or a single primary arteries
stenosis, greater than 70% or isolated branch stenosis greater than 70% without
allograft dysfunction

Cav 3- severe- angiographic left main greater than 50% or two primary arteries
greater than 70% stenosis or CAV1 or CAV2 with allograft dysfunction or evidence
of restrictive physiology



Question 5
Why is dioxin not given for atrial dysrhythmias after heart transplant?
Correct Answer
Digioxin affects are vagally mediated which is nerve based - once the heart
denervated it is not effective



Question 6
what are some warm ups and how long should a cardiac transplant patient do them
Correct Answer
5-10 minutes of leg pumping/ankle rolling prior to getting out of bed/walking to
prevent orthostatic hypotension



Question 7
what is indication for biventricular pacing
Correct Answer
QRS duration >120ms and Left bundle-branch block




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,Question 8
What are the causes of ventricular dysrhythmias after heart transplant
Correct Answer
Low potassium or magnesium
Rejection
Increased sensitivity of the heart to catecholamines and inotropes
Reperfusion injury
Prolonged ischemic time
Manipulation of donor heart



Question 9
what are the disadvantages of bicaval heart transplant
Correct Answer
longer surgical procedure prolonging ischemic time



Question 10
what are the treatment protocols for AMR
Correct Answer
Solumedrol 500-1000mg IV x3 days
Plasmapheresis 1.5 vol exchanges
IVIG
Rifaximab- 1gIV or 500mg x4 weeks
Thymo



Question 11
What is the cause of cardiac tamponade after heart transplant
Correct Answer
Trauma, laceration during pericardiocentesis, aortic dissection or MI with myocardial
rupture




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, Question 12
Is induction therapy used in patients with significant renal dysfunction
Correct Answer
Yes, induction agents allow the delayed start of CNI therapy thereby limiting the
nephrotoxic effects of these drugs



Question 13
what is the age limit for cardiac transplant
Correct Answer
<70



Question 14
What are interventions for difficulty weaning from CPB in the OR due to RV
dysfunction
Correct Answer
Inotropic agent
In setting of hypotension - administer inotropic agents and optimize RV preload via
volume resuscitation

If normal intensive systemic vasodilators, such as nitroglycerin may used or in the
setting of PA pressure is being elevated

Selective pulmonary vasodilators in the studying of persistent elevated PA pressure
greater than 45 mmHg and severe RV dysfunction

MCS if I'm going hemodynamic instability

For persistent, isolated, right ventricular failure prepare patient for return to OR for
implantation of an RV assist device. If etiology is due to obstruction at site of
pulmonary artery anastomosis also prepare patient for return to OR.




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