Pre operative tests in cardiothoracic surgery
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Pre Operative tests in Cardiothoracic Surgery. FBC. HB Anaemia ? Why Anticoagulation type of valve WCC neutrophilia neutropaenia True or false Prosthetic valve endocarditis has ~50% mortality PLT Thrombocytosis Thrombocytopaenia Aspirin and clopidogrel have no effect. U & E. Na

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Pre Operative tests in Cardiothoracic Surgery

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Pre operative tests in cardiothoracic surgery

Pre Operative tests in Cardiothoracic Surgery


Pre operative tests in cardiothoracic surgery

FBC

  • HB

    • Anaemia ? Why

    • Anticoagulation type of valve

  • WCC

    • neutrophilia

    • neutropaenia True or false

    • Prosthetic valve endocarditis has ~50% mortality

  • PLT

    • Thrombocytosis

    • Thrombocytopaenia

    • Aspirin and clopidogrel have no effect


Pre operative tests in cardiothoracic surgery

U & E

  • Na

    • Paraneoplastic in Ca lung

    • Confusion in old grannies

    • Diuretics

  • K

    • Arrthymias

  • Urea

    • GI bleed

    • Diuretic use

    • Dehydration

  • Creatinine

    • Major risk factor for dying post cardiac surgery


Lfts and calcium

LFTs and calcium

  • LFTs

    • Alcoholics major risk factor

    • Metastasis in lung cancer

    • Right heart failure

    • Drugs eg Statins

  • Ca2+

    • Metastasis in lung cancer

    • Paraneoplastic


Clotting

Clotting

  • Pro coagulant

    • Protein C

    • Protein S

    • antithrombin III

    • VonLeiden

    • Lupus anticoagulant ONLY ONE WITH ABNORMAL LABS

    • Block the grafts

  • Bleed

    • Monitor heparin and warfarin therapy and reversal

    • VonWillibrands

    • Haemophilia A

    • Christmas disease (Haemophilia B)


Glucose

Glucose

  • 1ST OR 2ND on list

  • Diabetes is major risk factor for dying

  • Poorly controlled means metabolic problems post operatively

  • Newly diagnosed in CABG patients

  • HBA1c or Fructosamine


Pre operative tests in cardiothoracic surgery

ECG

  • Normal or not

  • Rate eg brady or tachy

  • SR / AF

  • PR interval

  • LV hypertrophy

  • Bundle branch block

  • ST levels in CABG

  • ST curvature in lung and oesophageal cancer

  • Pacemaker


Pre operative tests in cardiothoracic surgery

PFTs

  • Epidural use

  • Nebuliser use

  • Risk of thoracotomy

  • Valve patients different to CABG patients

  • DLCO / VA

  • Thoracic surgery

    • Rule of 19 for predicting post operative FEV1


Cxr cardiac

CXR - Cardiac

  • Size heart

  • Risk

  • Cardioplegia

  • Trauma

  • Aortic calcification CVA risk eg Cannulation ? Off pump

  • Lung cancer as most are ex or current smokers

  • #ribs ? #sternum in past

  • Wires / clips from previous sternotomy

    • Beware Ethibond or wire removal

    • Think LIMA

    • Valves and Warfarin


Cxr thoracic

CXR - Thoracic

  • Size heart

  • Risk

  • Trauma

  • Growth of tumour

  • Pleural effusion

  • Pulmonary mets

  • #ribs ? #sternum in past

  • Wires / clips from previous sternotomy

    • Beware Ethibond or wire removal

    • Think LIMA especially in Left upper lobectomy

    • Valves and Warfarin


Cxr oesophageal

CXR - Oesophageal

  • Size heart

  • Pleural effusion

  • Pulmonary mets

  • ? see tumour

  • Wires / clips from previous sternotomy

    • Beware Ethibond or wire removal

    • Think LIMA

    • Valves and Warfarin


Angiogram isolated cabg

Angiogram – Isolated CABG

  • Aortic calcification

  • Amount aortic regurgitation

  • LV function

  • What needs doing

    • Conduits to use

      • LIMA

      • RIMA

      • Radial

      • Vein


Angiogram isolated valve

Angiogram – Isolated Valve

  • ? needs CABG

  • LMS length

  • Circ size in mitral surgery

  • Aortic calcification

  • Amount aortic regurgitation

  • LV function

  • Aortic valve calcification ? CVA risk


Ct cardiac

CT - Cardiac

  • Redo surgery ? RV and sternum separation

  • Aortic sizes ? Need root or arch

  • Follow up of descending aorta

  • Planning coarctation


Ct thoracic

CT - Thoracic

  • Thoracic surgery

    • Tumour

    • Mediastinal LNs

    • Metastatic spread


Ct oesophageal

CT - Oesophageal

  • Oesophageal Surgery

    • Tumour ? Left or Right approach

    • Trachea

    • Mets


Pre operative tests in cardiothoracic surgery

Echo

  • All murmurs need evaluating

  • Always check “supposedly normal valves”

  • Pulmonary and tricuspid valves rarely commented on with mitral valve patients

  • PA pressure MAJOR risk factor

  • LV and RV function


Weight

Weight

  • Tamponade

  • Leg wound healing

  • Breathless patients ? Need diuretics


Pre operative tests in cardiothoracic surgery

BP

  • Left and right arm for LIMA

  • Level that kidneys and brain expect

  • Aortic dissection


Swabs

Swabs

  • Sternal wound and valve infection

  • Prosthetic valve endocarditis mortality 30 to 50 %


Carotid scans

Carotid scans

  • Type of operation

  • Blood pressure on bypass

  • Risk of stroke

  • ? Combined procedure

  • Post operative medications


Clinical examination don t underestimate the importance of this

Clinical ExaminationDON’T UNDERESTIMATE THE IMPORTANCE OF THIS


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