Thorax 463340.An otherwise healthy married 25-year-old female medical student is
referred to your cardiology practice by her primary care physician for con-
sultation and evaluation. She has told her primary care physician that she
is thinking of starting a family. She has an atrial septal defect, diagnosed at
age 5, but did not undergo repair because her parents “didn’t want their
healthy daughter to undergo open-heart surgery.” Why are you going to
recommend that prior to her planned pregnancy that she at least considers
getting her atrial septal defect (ASD) repaired?
a. The pregnancy adds significant additional resistance to the peripheral venous
system because of the size of the placenta. This will cause a left to right atrial
shunt, which will cause hypertrophy of the left ventricle. In addition, there are
clamshell devices that may be inserted intravenously to repair the ASD that do
notrequire open-heart surgery
b. The pregnancy adds significant additional resistance to the peripheral venous
system because of the size of the fetal circulatory system. This will cause a right
to left shunt, which will cause hypertrophy of the left atrium. In addition, there
are clamshell devices that may be inserted intravenously to repair the ASD that
donotrequire open-heart surgery
c. You would notrecommend any treatment because living with an ASD carries no
risk if you have lived with it for 20 years
d. Pregnancy increases the chances of venous emboli, which might lead to stroke
because emboli might bypass the lung by passing through the ASD. In addition,
there are clamshell devices that may be inserted intravenously to repair the ASD
that do notrequire open-heart surgery
e. The pregnancy adds significant additional resistance to the peripheral venous
system because of the size of the fetal circulatory system. This will cause a left
to right shunt, which will cause hypertrophy of the right atrium. In addition,
now that she is older the risks of open-heart surgery are significantly reduced
compared to surgery as a child because the heart is much larger
341.Cardiothoracic surgeons must be familiar with bronchopulmonary
segments since individual segments of the lung can be removed, leaving
the rest of the lung intact and functional. Which of the following is a cor-
rect characterization of bronchopulmonary segments?
a. They are arranged with their bases directed toward the hilum of the lung
b. They are separated by parietal pleura
c. The arterial supply is located in the periphery of each segment
d. Each segment is supplied by a secondary or lobar bronchus
e. Veins may be used to localize the planes between segments