100+ Free Título em Cirurgia Cardiovascular SBCCV Practice Questions

Anatomia e Fisiologia Cirúrgica Cardiovascular

Coronary artery branch anatomy and variations (conus branch, sinus node artery, diagonal, obtuse marginal, posterior descending artery - PDA, posterolateral branches), coronary venous system (coronary sinus, great/middle/small cardiac veins), conduction tissue topography (Triangle of Koch bounded by the tendon of Todaro, tricuspid septal annulus, and coronary sinus ostium containing the AV node and bundle of His), central fibrous body, aortic root architecture (annulus, sinuses of Valsalva, interleaflet triangles, sinotubular junction), mitral and tricuspid subvalvular apparatus (papillary muscles, chordae tendineae), and pericardial sinuses (transverse sinus of Theile and oblique sinus of Haller).

Circulação Extracorpórea (CEC) e Proteção Miocárdica

Cardiopulmonary bypass (CPB) principles, circuit configuration, roller vs. centrifugal arterial pumps, membrane oxygenators, venous reservoirs, arterial line filters; cannulation techniques (ascending aorta, femoral, axillary/subclavian artery; bicaval with snares, dual-stage cavoatrial); systemic anticoagulation with unfractionated heparin (target ACT > 480 seconds) and protamine neutralization (1 mg per 100 IU heparin); hemodilution physiology, prime solutions, ultrafiltration (conventional vs. modified ultrafiltration - MUF); systemic hypothermia levels and rewarming rates; acid-base management (alpha-stat vs. pH-stat); myocardial protection concepts, cardioplegic arrest mechanics (hyperkalemia, resting membrane potential), crystalloid (St. Thomas, Bretschneider/Custodiol HTK) vs. blood cardioplegia (cold blood 4:1, warm induction/reperfusion, Del Nido single-dose solution), antegrade vs. retrograde coronary sinus infusion, and CPB-induced systemic inflammatory response syndrome (SIRS).

Doença Arterial Coronariana Cirúrgica (Revascularização do Miocárdio - RM)

Indications for surgical revascularization (CABG) vs. PCI based on SYNTAX score, unprotected left main coronary artery stenosis (≥50%), 3-vessel disease with diabetes mellitus or reduced LV ejection fraction; arterial conduits (Left Internal Thoracic Artery - LITA to LAD as gold standard, Bilateral Internal Thoracic Arteries - BITA, Radial Artery) and venous conduits (Great Saphenous Vein - GSV harvested via open, endoscopic, or no-touch technique); sequential and composite Y-grafting; on-pump CABG vs. Off-Pump CABG (OPCAB); surgical management of post-infarction mechanical complications: Post-Infarction Ventricular Septal Rupture (VSR / Daggett vs. David patch exclusion techniques), Acute Mitral Regurgitation from Papillary Muscle Rupture (posteromedial papillary muscle single blood supply from PDA), Left Ventricular Free Wall Rupture (blowout vs. oozing type), and Left Ventricular Aneurysmectomy (Dor endoventricular patch reconstruction).

Doenças Valvares e Procedimentos de Plastia / Troca Valvar

Pathophysiology and surgical indications for Aortic Stenosis and Aortic Regurgitation (severe AS AVA < 1.0 cm2 or mean gradient ≥ 40 mmHg; symptomatic or LVEF < 50%); prosthesis selection (mechanical bileaflet vs. stented/stentless bioprostheses, transcatheter valves / TAVI); aortic root enlargement techniques (Nicks, Manouguian, Konno-Rastan); Ross procedure (pulmonary autograft to aortic position with pulmonary homograft) and Ozaki procedure (autologous pericardial aortic cusp reconstruction); Mitral valve pathology (degenerative mitral regurgitation / fibroelastic deficiency vs. Barlow disease, rheumatic mitral stenosis, functional MR); Carpentier classification (Types I, II, IIIa, IIIb); Mitral valve repair techniques (rigid/semi-rigid annuloplasty rings, artificial ePTFE chordal replacement, triangular/quadrangular leaflet resection, edge-to-edge Alfieri stitch); Tricuspid valve repair (rigid ring annuloplasty vs. De Vega / Kay suture annuloplasty); Surgical management of Infective Endocarditis (indications for emergency/urgent surgery: refractory heart failure, persistent bacteremia, fungal/resistant organism, vegetation > 10 mm with embolic event, annular abscess debridement and aortic-mitral curtain patch reconstruction).

Doenças da Aorta Torácica e Grandes Vasos

Acute aortic syndromes: Stanford Type A (ascending aorta involvement, emergency surgical indication) vs. Type B (distal to left subclavian artery, medical therapy vs. TEVAR for complicated cases: malperfusion, rupture, rapid expansion, intractable pain/hypertension); Ascending aortic aneurysm repair thresholds (≥5.5 cm general, ≥5.0 cm with bicuspid aortic valve / connective tissue disease - Marfan, Loeys-Dietz, or ≥4.5 cm with concomitant aortic valve surgery); Aortic root surgery: Composite valve graft (Bentall-De Bono with coronary reimplantation) vs. Valve-Sparing Root Replacement (David reimplantation procedure vs. Yacoub remodeling procedure); Aortic arch surgery: Hemiarch vs. Total arch replacement with elephant trunk and Frozen Elephant Trunk (FET / Thoraflex / E-vita); Cerebral protection strategies during arch arrest: Deep Hypothermic Circulatory Arrest (DHCA at 18–20°C), Antegrade Selective Cerebral Perfusion (ASCP unilateral vs. bilateral via axillary/innominate cannulation at 24–28°C), and Retrograde Cerebral Perfusion (RCP); Descending thoracic aorta and thoracoabdominal aortic aneurysms (Crawford classification Types I-V), spinal cord ischemia prevention (CSF drainage, distal aortic perfusion, motor evoked potential monitoring, hypothermia, reattachment of critical intercostal arteries T8-L2 / Artery of Adamkiewicz).

Cardiopatias Congênitas (Acianogênicas e Cianogênicas)

Acyanotic congenital heart defects: Atrial Septal Defect (Ostium secundum, Ostium primum / partial AV canal, Sinus venosus superior with anomalous right upper pulmonary venous return / Warden procedure vs. single/double patch repair, coronary sinus ASD); Ventricular Septal Defect (Perimembranous / infracristal relation to conduction bundle, Muscular, Subpulmonic / supracristal / Doubly committed subarterial, Inlet); Atrioventricular Septal Defect (complete AV canal / two-patch vs. one-patch repair); Patent Ductus Arteriosus (surgical ligation/division); Coarctation of the Aorta (extended end-to-end anastomosis, patch aortoplasty, subclavian flap / Waldhausen). Cyanotic congenital heart defects: Tetralogy of Fallot (pathognomonic tetrad: VSD, overriding aorta, RVOT obstruction, RV hypertrophy; primary repair with VSD closure and RVOT resection / transannular patch vs. palliative modified Blalock-Taussig shunt); Transposition of the Great Arteries (TGA - Arterial Switch Operation / Jatene procedure with coronary artery button transfer within first weeks of life vs. atrial switch Senning / Mustard in late presentation); Total Anomalous Pulmonary Venous Connection (TAPVR supracardiac, cardiac, infracardiac, mixed); Truncus Arteriosus; Ebstein's Anomaly (Cone repair / da Silva technique); Single Ventricle Physiology and Palliation Pathway: Stage 1 Norwood procedure (with modified BT shunt or Sano RV-PA conduit) / Damus-Kaye-Stansel for Hypoplastic Left Heart Syndrome (HLHS), Stage 2 Bidirectional Glenn (superior cavopulmonary anastomosis at 4–6 months), and Stage 3 Fontan / Total Cavopulmonary Connection (TCPC extracardiac conduit with fenestration at 2–4 years).

Transplante Cardíaco e Assistência Circulatória Mecânica

Heart transplantation: Recipient listing criteria, contraindications (severe irreversible pulmonary hypertension PVR > 4-5 Wood units), Brazilian national prioritization criteria (SNT - cardiogenic shock on high-dose inotropes, balloon pump, ECMO, or ventricular assist device); Donor evaluation criteria (echocardiography, inotropic requirements, ischemic time < 4 hours); Surgical techniques: Standard biatrial (Lower-Shumway) vs. Bicaval orthotopic heart transplantation (preserves right atrial geometry, lowers tricuspid regurgitation and sinus node dysfunction); Post-transplant immunosuppression (triple therapy: calcineurin inhibitor - tacrolimus/cyclosporine, antiproliferative - mycophenolate mofetil, corticosteroids); Diagnosis and management of Acute Cellular Rejection (ISHLT grading 0R-3R, endomyocardial biopsy) and Antibody-Mediated Rejection (AMR); Cardiac Allograft Vasculopathy (CAV); Mechanical Circulatory Support (MCS): Intra-Aortic Balloon Pump (IABP principles, counterpulsation timing, deflation before systole); Extracorporeal Membrane Oxygenation (ECMO): Venoarterial (VA-ECMO) for cardiogenic shock, peripheral cannulation, Harlequin syndrome / differential hypoxemia (upper body hypoxia), left ventricular overload/distension and venting strategies (percutaneous atrial septostomy, Impella, surgical LV vent); Venovenous (VV-ECMO) for isolated respiratory failure; Durable Left Ventricular Assist Devices (LVAD - continuous-flow centrifugal pumps / HeartMate 3, full magnetic levitation, surgical implantation technique, management of adverse events: pump thrombosis, gastrointestinal bleeding from acquired von Willebrand syndrome, driveline infection, right ventricular failure).

Cirurgia das Arritmias e Eletrofisiologia Cirúrgica

Surgical treatment of Atrial Fibrillation: Cox-Maze IV procedure, biatrial lesion set using bipolar radiofrequency and cryothermal ablation, pulmonary vein isolation, box lesion, mitral and tricuspid annular lines; Left Atrial Appendage (LAA) management: surgical excision, endocardial suture closure, stapling, epicardial clip application (AtriClip); Permanent cardiac pacing in cardiac surgery: Epicardial vs. transvenous lead placement, indications for dual-chamber (DDD) pacing in postoperative complete AV block; Cardiac Resynchronization Therapy (CRT-P / CRT-D) coronary sinus lead placement vs. epicardial LV lead; Implantable Cardioverter-Defibrillators (ICD); Surgical management of CIED (Cardiac Implantable Electronic Device) infections: Complete system explantation and transvenous lead extraction.

Pós-Operatório e Terapia Intensiva Cardiovascular (UTI)

Advanced hemodynamic monitoring: Pulmonary Artery Catheter (Swan-Ganz parameters: CI, SVR, PVR, PCWP, mixed venous oxygen saturation - SvO2), arterial waveform analysis; Low Cardiac Output Syndrome (LCOS): differential diagnosis, inotropic support (epinephrine, dobutamine, milrinone, levosimendan); Vasoplegic Syndrome: criteria (CI > 2.5 L/min/m2, SVRI < 1200 dyn·s/cm5), high-dose vasopressor therapy (norepinephrine, vasopressin, angiotensin II) and rescue therapies (methylene blue 1.5–2 mg/kg, hydroxocobalamin); Acute Postoperative Bleeding: coagulation monitoring with Viscoelastic Testing (Thromboelastography - TEG / ROTEM), transfusion thresholds, protamine dosing, factor concentrates (4F-PCC, fibrinogen concentrate), surgical resternotomy indications (chest tube drainage > 400 mL in 1st hour, > 200 mL/h for 2 consecutive hours, or sudden cessation with hemodynamic compromise); Acute Cardiac Tamponade: clinical presentation, atypical presentation on CPB/post-cardiotomy (localized retrocardiac clot causing isolated left atrial/pulmonary venous compression), bedside echocardiography, emergency resternotomy in ICU; Postoperative Pulmonary Hypertension and Right Ventricular Failure: inhaled nitric oxide (iNO), inhaled prostacyclin (iloprost), PDE-5 inhibitors.