Case 13 Part 9




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What's inside?


 

Heart
Scarring
Coronary artery bypass graft
Saphenous vein graft
Graft ostium
Tricuspid valve
Pulmonic valve
Mitral valve
Aortic valve
Papillary muscle
Chordae tendineae




This is a "High Independence" case. There is no explanatory audio.
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Discussion Questions


 

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(Video times provided)
1. 00:02
Orient the organs. Is the view anterior or posterior? Which side of the screen represents superior, inferior, left lateral or right lateral?
 
 
2. 00:02
What organs are visible?
 
 
3. 00:02 – 00:18
What are the wires visible? Where did they attach at the cut end? Where does each attach inside the heart? Can you identify a bypass graft in this view? What anatomic territory does it supply? What vessel do you think it likely bypassed?
 
 
4. 00:22
Orient the heart. Is the view anterior or posterior? Which side of the screen represents superior, inferior, left lateral or right lateral?
 
 
5. 00:22 – 00:37
Why is the surface of the heart so ragged? What does the surface of the heart normally look like after bypass surgery? Can you identify a bypass graft in this view?
 
 
6. 00:39
Orient the heart. Is the view anterior or posterior? Which side of the screen represents superior, inferior, left lateral or right lateral?
 
 
7. 00:39 – 00:50
Identify the bypass graft. It has been opened. What anatomic territory does it supply? What vessel do you think it likely bypassed? Based on this view, do you think the graft was functional? Where else would you check to confirm the graft was functional? What is early graft closure? Does this patient have it?
 
 
8. 00:54 – 01:10
What is the metal structure? What was its purpose? Was this inside a graft or a native vessel?
 
 
9. 01:12 – 01:30
Is this a view of the right side of the heart or the left side of the heart? What chambers are we looking at? Identify the septumuscle Name the valve. Where do the wires insert? What was their purpose? Identify trabeculae carneae, papillary muscles and chordae tendineae.
 
 
10. 01:48
What valve is this? Does it appear normal?
 
 
11. 02:02
What valve is this? Why is there a slit in it? Does it otherwise appear normal? Identify papillary muscles and chordae tendineae.
 
 
12. 02:18 – end
What valve is this. Does it appear normal. Can you identify any native ostia? How many? Can you identify any surgical ostia? How many? The patient likely had an additional bypass graft that would not be visible in this view. What graft would that be?




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