Chapter 25 Thoraic Aneurysm Repair
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Questions and Answers

What is the primary cause of TAAs?

  • Infection
  • Connective tissue disease
  • Atherosclerotic degenerative disease (correct)
  • Chronic aortic dissection

What symptom may be felt in the neck and jaw for patients with TAAs?

  • Wheezing
  • Dyspnea
  • Pain (correct)
  • Stridor

How is the repair of the descending thoracic aorta usually performed?

  • With a patch graft
  • With the patient in supine position
  • Without clamping of the thoracic aorta
  • Usually with a tube graft (correct)

What contributes to the potential for rupture in a thoracic aortic aneurysm?

<p>Rapidly expanding lesions (A)</p> Signup and view all the answers

How does a descending thoracic aortic aneurysm affect the airway?

<p>Causes tracheal deviation and compression of the left mainstem bronchus (A)</p> Signup and view all the answers

What is the potential blood loss range during repair of a thoracic aortic aneurysm?

<p>5000 to 8000 mL (A)</p> Signup and view all the answers

What is the expected normal diameter of an aorta?

<p>3.5 cm (A)</p> Signup and view all the answers

What type of surgery is the 67-year-old man scheduled for?

<p>Descending Thoracic Aneurysm repair (D)</p> Signup and view all the answers

What is the goal of placing the distal clamp along the aorta during aortic surgery?

<p>To minimize visceral ischemia (B)</p> Signup and view all the answers

What is the key risk factor for aneurysm formation, often evident preoperatively?

<p>Chronic hypertension (A)</p> Signup and view all the answers

What strategy may be used to manage asymptomatic thoracic aortic aneurysms with an anteroposterior diameter less than 5 to 6 cm?

<p>Medical management (A)</p> Signup and view all the answers

Why is the right radial artery preferred for blood pressure assessment during a descending aorta repair?

<p>Aortic cross-clamping can occasionally be required proximal to the left subclavian artery (D)</p> Signup and view all the answers

Why is pulmonary artery occlusion pressure (PAOP) deemed unreliable during one-lung anesthesia (OLA)?

<p>PAOP may substantially overestimate the LVEDPs during OLA (C)</p> Signup and view all the answers

Why is transesophageal echocardiography (TEE) considered a routine modality for intraoperative monitoring during thoracic aorta surgery?

<p>It is a noninvasive technique used to assess biventricular function, volume status, and myocardial ischemia (D)</p> Signup and view all the answers

What is the primary concern during induction of anesthesia for thoracic aorta surgery?

<p>Preventing myocardial ischemia or infarction (B)</p> Signup and view all the answers

What is the standard practice for lung separation during surgeries of the descending thoracic aorta?

<p>Placement of a double-lumen endotracheal tube (DLT) (C)</p> Signup and view all the answers

What poses a risk necessitating the use of a right-sided DLT during surgeries of the descending thoracic aorta?

<p>Pulsatile compression or Frank erosion within the left bronchus (B)</p> Signup and view all the answers

What is the physiological impact of aortic clamping during repair of a TAA?

<p>Decrease in ventricular ejection and rise in LVEDP (A)</p> Signup and view all the answers

How does hypotension occur during the unclamping of the aorta?

<p>Resulting from massive peripheral vasodilation and blood redistribution (D)</p> Signup and view all the answers

What intervention may be necessary to stabilize blood pressure after the removal of the aortic clamp?

<p>Aggressive volume loading (C)</p> Signup and view all the answers

What is the primary purpose of distal perfusion techniques during complex repairs of the descending aorta?

<p>To maintain lower body perfusion and reduce ischemic injury (C)</p> Signup and view all the answers

Which of the following is true about the Gott shunt used in distal perfusion techniques?

<p>It is heparin coated, eliminating the need for systemic heparinization (A)</p> Signup and view all the answers

What is the purpose of partial bypass or left-heart bypass in distal aortic perfusion?

<p>To direct blood from the left atrium to the left femoral artery (C)</p> Signup and view all the answers

How is the integrity of the spinal cord usually assessed during thoracic aortic surgery?

<p>Using evoked potentials to measure amplitude and latency (A)</p> Signup and view all the answers

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