CIRCULATORY ASSIST TECHNIQUES

Maria Helena L. Souza, CCP (Br)

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QUESTIONS

1. As litlle as a decade ago heart failure was considered a terminal condition with few, if any, effective therapeutic options. Heart failure is now a condition where multiple effective therapies exist and much can be achieved to improve survival and life quality in affected patients.

true
false

2. In western industrialized societies, the most common underlying causes of heart failure are all of the following, except:

ischemic heart disease
hipertension
nutritional deficiencies
dilated cardiomyopathy

3. Five students discussed the basic knowledge of heart failure. Andy stated that hypertension remains as an important cause of heart failure. Barbara said that the incidence of heart failure in the UK is about 20-30 per thousand per year. Clark stated that the incidence of heart failure decreases in the elderly patient. Daisy stated that chronic heart failure is the most common single reason for admission to hospital in people aged over 65 years. Finally Edward said that specially designed physical training programs can improve the exercise capacity in heart failure patients. In your opinion which student made a wrong statement in relation to the heart failure ?

Andy
Barbara
Clark
Daisy
Edward

4. In heart failure the left ventricle presents changes in all of the following, except:

size
shape
structure
function
relations

5. Low cardiac output is treated by positive inotropic agents provided an adequate preload exists (adequate left ventricular end-diastolic pressure). If the LVEDP is low, this is transmitted to the pulmonary veins, leading to eventual extravasation of fluid into the alveoli and pulmonary edema.

true
false

6. Whereas systole occurs rapidly and in one action, diastole is complex, with an initial rapid and active ventricular recoil producing rapid filling of the ventricle, then a period of relative stasis as atrial and ventricular pressures equilibrate, followed by a second period of ventricular filling produced by the effects of atrial contraction. The following may interfere with ventricular diastolic function:

atrial fibrillation
A-V block
changes in heart rate
all of the above
none of the above

7. Five students discussed surgical options to treat heart failure. Andy stated that the short-term goal of medical treatment for heart failure is to improve the patient's quality of life by the relief of symptoms but such treatment has modest success in improving patient survival. Barbara agreed with Andy and added that some patients because of their relative youth and lack of comorbid conditions, become candidates for heart transplantation. Clark said that improved immunosuppression treatment is needed to enhance graft survival and possibly expand the donor pool to include other species. Daisy stated that the progress in the past 10 years has made available several mechanical implantable devices, which can be used by patients outside the hospital. Finally Edward stated that the available mechanical devices are not indicated as a bridge to transplant. In your opinion which student made a wrong statement in relation to the surgical treatment of heart failure ?

Andy
Barbara
Clark
Daisy
Edward

8. Mechanical circulatory support is useful in patients who require ventricular assistance to allow the heart to rest and recover its function, such as postcardiotomy shock patients.

true
false

9. Survival os postcardiotomy shock patients has been reported as:

about 50%
lower than 10%
higher than 80%
about 25%
about 75%

10. For patients who cannot be weaned from cardiopulmonary bypass, use of a short-term extracorporeal device is the most appropriate treatment.

true
false

11. All of the following have been considered contraindications to the implant of a left ventricular assist device, except:

body weight less than 50 kg
body surface area less than 1.5 m²
recent neurological deficit
moderate renal impairment
high bilirubin level

12. In 1985 the first clinical case of "dynamic cardiomyoplasty", in which a muscle graft applied to the left ventricular surface was stimulated with a cardiac pacemaker to contract in syncrony with the heart, was successfully performed by:

Salmons
Cooley
Kirklin
Favaloro
Carpentier

13. Major complications observed with all mechanical implantable pulsatile devices are:

bleeding
thrombosis
infection
all of the above
none of the above

14. All of the following pumps belong to the category of displacement blood pumps, except:

HeartMate
Novacor
LionHeart
Thoratec
Hemopump

15. In patients under maximal pharmacologic support, specific criteria to indicate the placement of a left ventricular assist device include:

PCWP > 20 mmHg
SBP < 80 mmHg
CI < 2.0 l/min/M²
all of the above
none of the above

16. All of the following represent different types of blood pumps available for mechanical circulatory assistance, except:

displacement pumps
axial pumps
radial pumps
diagonal pumps
square pumps

17. Five students discussed the basic knowledge on mechanical circulatory support devices. Andy stated that initially mechanical circulatory support devices were developed as a permanent replacement and they were designed to compete in the field of cardiac transplantation. Barbara agreed with Andy and added that today most of the devices are used as mechanical bridges in patients awaiting heart transplantation. Clark agreed with Barbara and stated that a complete recovery from secondary organ dysfunction after cardiogenic shock has to be achieved before transplantation can be considered and early implantation of the assist device can help to minimize liver, kidney and brain damage due to low cardiac output and thereby improve patient outcome. Daisy stated that some technical modifications with the devices presently available were able to increase patient mobility and decrease the incidence of major device-related complications. Finally Edward said that modern mechanical circulatory support devices do not require anticoagulation. In your opinion which student made a wrong statement in relation to the mechanical circulatory support devices ?

Andy
Barbara
Clark
Daisy
Edward

18. Which of the following represents an example of a paracorporeal, pneumatically driven mechanical circulatory support device ?

Thoratec
Hemopump
HeartMate II
Abiomed
none of the above

19. As of February 1999, 1048 patients were implanted with Thoratec VAD in over 100 medical centers across 21 countries. Mean support duration was 38 days in the bridge to transplant patients. Survival to transplantation in the BTT group was approximately:

10%
30%
40%
50%
60%

20. Reported results indicate that mechanical circulatory support devices offer the best results as a:

bridge to recovery
bridge to transplant
long-term replacement
all of the above
none of the above

C.E.Quiz is dedicated to the Continuing Education in Extracorporeal Technology.

Your comments on C.E. Quiz are appreciated. Please contact: Maria Helena L. Souza