Complications of Surgery of Aortic aneurysm

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Answer for premium - Discuss the complications of Surgery for aortic aneurysm

Aortic rupture

Q) Most common site for traumatic aortic rupture is 

a) Distal to the origin of left subclavian artery

b) Point of entry of aorta above the diaphragm

c) Root of aorta

d) Point distal to Left carotid artery

Answer 

a) Distal to origin of subclavian artery

Traumatic aortic rupture leads to sudden death after high impact automobile accident or fall from height. Aorta is relatively fixed distal to ligament arteriosum just distal to the origin of subclavian artery and this is the most common site of traumatic rupture especially partial rupture in which adventitia is intact.

Specific clinical findings are 

  1. Asymmetry of BP in upper limbs or upper and lower limbs
  2. Widened pulse pressure
  3. Chest wall contusions

Bailey page 355

http://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/aortic-disruption-traumatic

Atrial Septal Defect

 In exams like DNB SS questions on ASD and VSD are common. Most cardiac surgery questions are here

Q) Most common ASD is 

a) Ostium Primum

b) Ostium Secundum

C) Sinus Venosus

d) All are equal

Answer 

b

Ostium Secundum

 

ASDs
Common defects
Ostium secundum: fossa ovalis defect (approximately 70 per cent of ASDs)
Ostium primum: atrioventricular septal defect (approx imately 20 per cent of ASDs)
Sinus venosus defect: often associated with anomalous pulmonary venous drainage (approximately 10 per cent of ASDs)
Patent foramen ovale: common in isolation, usually no left-to-right shunt (not strictly an ASD)

Rarer defects
Inferior vena cava defects: a low sinus venosus defect and may allow shunting of blood into the left atrium
Coronary sinus septal defect: also known as unroofed coronary sinus with the left superior vena cava draining to the left atrium as part of a more complex lesion