ABCP BOARDS EXAM TEST VERIFIED SOLUTIONS LATEST UPDATE 2023

ABCP BOARDS EXAM TEST VERIFIED SOLUTIONS LATEST UPDATE 2023 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 What are the benefits of bicaval "island" cuffs in heart transplantation? - ANSWER 1) decrease the distortion of tricuspid valve 2) improve right heart function 3) decrease risk of thrombolic emboli 4) lower right sided pressures 5) won't need pacemaker as often 6) decreases regurgitance 7) no 2nd P-wave