Chapter 25 Thoraic Aneurysm Repair

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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?

Rapidly expanding lesions Signup and view all the answers

How does a descending thoracic aortic aneurysm affect the airway?

Causes tracheal deviation and compression of the left mainstem bronchus Signup and view all the answers

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

5000 to 8000 mL Signup and view all the answers

What is the expected normal diameter of an aorta?

3.5 cm Signup and view all the answers

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

Descending Thoracic Aneurysm repair Signup and view all the answers

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

To minimize visceral ischemia Signup and view all the answers

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

Chronic hypertension 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?

Medical management Signup and view all the answers

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

Aortic cross-clamping can occasionally be required proximal to the left subclavian artery Signup and view all the answers

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

PAOP may substantially overestimate the LVEDPs during OLA Signup and view all the answers

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

It is a noninvasive technique used to assess biventricular function, volume status, and myocardial ischemia Signup and view all the answers

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

Preventing myocardial ischemia or infarction Signup and view all the answers

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

Placement of a double-lumen endotracheal tube (DLT) 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?

Pulsatile compression or Frank erosion within the left bronchus Signup and view all the answers

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

Decrease in ventricular ejection and rise in LVEDP Signup and view all the answers

How does hypotension occur during the unclamping of the aorta?

Resulting from massive peripheral vasodilation and blood redistribution Signup and view all the answers

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

Aggressive volume loading Signup and view all the answers

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

To maintain lower body perfusion and reduce ischemic injury Signup and view all the answers

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

It is heparin coated, eliminating the need for systemic heparinization Signup and view all the answers

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

To direct blood from the left atrium to the left femoral artery Signup and view all the answers

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

Using evoked potentials to measure amplitude and latency Signup and view all the answers