ABCP BOARDS EXAM TEST VERIFIED SOLUTIONS LATEST UPDATE

ABCP BOARDS EXAM TEST VERIFIED SOLUTIONS LATEST UPDATE Who was granted a federal contract in 1986 to operate the organ procurement and transplantation network? - ANSWER UNOS (United Network of Organ Sharing) In the 1980" there was an sudden increase in organ transplantation, Why? - ANSWER wide spread use of anti-rejection medications Why get a "used" heart? - ANSWER 1) NHLBI- end stage cardiac disease 2) NYHA class III and IV CHF a) refractory to max medical treatment b) continuous mechanical or inotropic support required c) Peak O2 uptake (VO2 max) <14ml/kg/min d) LVEF< 20% 3) Refractory angina pectoris- inoperable CAD 4) Refractory ventricular arrhythmias- life threatening 5) Myocardial tumor- w/o metastasis Who gets new hearts? - ANSWER 1) Status 1A- 1st to get heart: critically ill, in ICU, adv life support 2) Status 1B: 2nd: Require IV inotropes, hospital or home care 3) Status 2: 3rd in line: No IV meds required, usually not hospitalized Who absolutely contraindicated to receive heart transplant? - ANSWER 1) terminal malignancy 2) severe, irreversible major organ disease- multi-organ failure 3) Active infection 4) HIV 5) current alcohol or IV drug use Who have relative contraindications for heart transplant? - ANSWER 1) old people >65 2) severe CVD or PVD 3) IDDM- insulin deppendent DM 4) Pulmonary infarction or hypertension 5) morbid obesity 6) major psychiatric disorder- won't be compliant w/ meds Why can't a patient drink alcohol and receive a heart transplant? - ANSWER because cyclosporin is metabolized in liver Who can donate a heart? - ANSWER 1) confirmed brain death and organ viability 2) EKG evaluation of heart function 3) coronary angiogram male>40 female>45: no severe CAD 4) ABO blood group matching <20% reactive antibodies or is plasmapheresed Who absolutely can't donate a heart? - ANSWER 1) syphilis, HTLV-4, HIV 2) malignancy w/ extracranial metastasis 3) LVEF <40% 4) Significant valvular abnormality 5) significant CAD Who has relative contraindications to heart donation? - ANSWER 1) Thoracic trauma 2) Sepsis 3) HepB surface antigen -positive 4) repeated CPR 5) high dose inotrpic support > 24 hrs What is the heart haversting procedure? - ANSWER 1) kidneys and liver removed 1st 2) donor heparinized 3) heart excised "en bloc" 4) SVC and IVC ligated 1st: allows for exsanguination 5) Aorta X-clamped: is cross-clamp time 6) Cold CPG administered 7) Aorta and PA transected: left as long as possible 8) Pulmonary Veins individually divided 9) Pericardium preserved What are 4 types of heart transplants? - ANSWER 1) Orthotopic :98%: replace w/ new donor heart 2) Heterotopic: 2%: 2 hearts in parallel circulation 3) Live donor: donor hrt and lung goes in and reciepient hrt to someone else 4) deceased donor What is the cannulation for orthotopic heart transplant? - ANSWER 1) redo's: femoral 2) Aortic 3) bicaval venous In the original bi-atrial surgery, how is the recipient heart surgery performed? Why was this a problem? - ANSWER 1) native RA and LA preserved to preserveSA node and native rate 2) created a clot haven and has 2nd P-wave In Bicaval cannulation heart surgery, how is the recipient heart surgery performed? - ANSWER 1) LA cuff w/ PV's: make an island 2) SVC and IVC cuffs: make an island