NEET SS Cardiothoracic and Vascular Surgery (MCh) Syllabus

Cardiothoracic and Vascular Surgery (MCh) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Cardiothoracic and Vascular Surgery (MCh) in NEET SS, not a summary of it.

1. 1

   Cardiopulmonary Bypass and Perioperative Care

   3 topics

   • Extracorporeal Circulation
     • Cardiopulmonary bypass circuit and cannulation
     • Myocardial protection and cardioplegia
   • Postoperative Cardiac Surgical Care
     • Low cardiac output syndrome
     • Mechanical circulatory support (IABP, ECMO)
   • Perioperative Risk Assessment
     • EuroSCORE and STS scoring
2. 2

   Coronary and Valvular Cardiac Surgery

   3 topics

   • Coronary Artery Bypass Grafting
     • Conduit selection and graft patency
     • Off-pump CABG
   • Valve Repair and Replacement
     • Mechanical vs bioprosthetic valves
     • Mitral valve repair techniques
   • Surgery for Endocarditis and Aortic Root
     • Bentall procedure
3. 3

   Congenital Heart Surgery

   3 topics

   • Acyanotic Congenital Lesions
     • ASD, VSD and PDA repair
   • Cyanotic Congenital Lesions
     • Tetralogy of Fallot and TGA
     • Single ventricle and Fontan pathway
   • Palliative and Staged Procedures
     • Systemic-to-pulmonary shunts
     • Bidirectional Glenn
4. 4

   Thoracic and Vascular Surgery

   3 topics

   • Lung and Mediastinal Surgery
     • Lung resection for malignancy
     • Mediastinal masses and thymectomy
   • Esophageal Surgery
     • Esophagectomy
   • Aortic and Peripheral Vascular Surgery
     • Aortic aneurysm and dissection repair
     • Peripheral arterial occlusive disease

Cardiothoracic and Vascular Surgery (MCh) flashcards for NEET SS

21 of 50 cards from the Cardiothoracic and Vascular Surgery (MCh) deck — real questions with worked answers.

1. What is the normal flow rate index used for full cardiopulmonary bypass (CPB) in an adult at normothermia?

   Approximately 2.2-2.4 L/min/m2 (cardiac index) is targeted for full flow at normothermia.

2. During hypothermic cardiopulmonary bypass, what happens to required pump flow rates and why?

   Flow rates can be reduced because hypothermia lowers metabolic oxygen demand (roughly halving O2 consumption for every ~10C drop), allowing safe perfusion at lower flows.

3. What is the target activated clotting time (ACT) before initiating cardiopulmonary bypass?

   ACT must be >400-480 seconds (after full heparinization, typically 300-400 U/kg heparin) before going on bypass.

4. Which drug reverses heparin at the end of cardiopulmonary bypass, and what is the typical dose ratio?

   Protamine sulfate; roughly 1 mg protamine per 100 units of heparin given (1-1.3 mg/100 U).

5. What is the purpose of cardioplegia during open heart surgery?

   To arrest the heart in diastole and protect the myocardium ischemically, usually via a high-potassium (depolarizing) solution that stops electromechanical activity and reduces metabolic demand.

6. Differentiate antegrade versus retrograde cardioplegia delivery.

   Antegrade is delivered into the aortic root/coronary ostia following normal coronary flow; retrograde is delivered via the coronary sinus, useful with severe coronary stenoses or aortic regurgitation.

7. What is deep hypothermic circulatory arrest (DHCA) and a typical temperature used?

   Cessation of circulation under deep hypothermia (~18-20C) to allow a bloodless operative field, commonly for aortic arch surgery; safe arrest time is limited (~30-40 min) before neurologic injury risk rises.

8. Name the most common cause of low cardiac output syndrome (LCOS) in the early period after cardiac surgery.

   Myocardial dysfunction/stunning, often compounded by hypovolemia, tamponade, arrhythmia, or residual surgical lesions.

9. What clinical triad/signs should raise suspicion of cardiac tamponade after cardiac surgery?

   Hypotension, rising/equalizing filling pressures (raised CVP), falling cardiac output, with decreasing chest tube output and a widened mediastinum; pulsus paradoxus may be present.

10. What is the most common sustained arrhythmia after cardiac surgery and a typical timing?

    Atrial fibrillation, peaking around postoperative day 2-3, occurring in roughly 20-40% of CABG patients.

11. How does an intra-aortic balloon pump (IABP) improve myocardial performance?

    It inflates in diastole (augmenting coronary perfusion) and deflates in systole (reducing afterload/LV workload), improving the myocardial oxygen supply-demand balance.

12. What is the EuroSCORE used for in cardiac surgery?

    It is a risk-stratification model estimating operative (30-day) mortality from patient, cardiac, and operation-related factors; EuroSCORE II is the updated logistic version.

13. In perioperative cardiac risk, what additive STS score predicts and a key difference from EuroSCORE?

    The Society of Thoracic Surgeons (STS) score predicts operative mortality and major morbidity; it is derived from a large North American database and includes more morbidity endpoints than EuroSCORE.

14. What preoperative ejection fraction threshold generally defines high surgical risk / severe LV dysfunction?

    LVEF <30-35% indicates severe dysfunction and significantly increased perioperative risk.

15. What is the recommended timing for non-cardiac/cardiac surgery after a bare-metal versus drug-eluting coronary stent regarding dual antiplatelet therapy?

    Elective surgery is ideally delayed at least 1 month after a bare-metal stent and at least 6 months (preferably 12) after a drug-eluting stent to allow completion of DAPT and reduce stent thrombosis.

16. Which coronary graft has the best long-term patency in CABG, and what is its approximate 10-year patency?

    The left internal mammary (thoracic) artery to the LAD; roughly 90% patency at 10 years.

17. What is the approximate 10-year patency of a saphenous vein graft in CABG?

    Approximately 50-60% at 10 years, markedly lower than arterial grafts due to intimal hyperplasia and atherosclerosis.

18. What does 'off-pump' CABG (OPCAB) mean and a potential advantage?

    CABG performed on a beating heart without cardiopulmonary bypass, using stabilizers; potential advantages include avoiding CPB-related inflammation, reduced transfusion, and possibly fewer strokes.

19. According to SYNTAX score logic, when is CABG generally favored over PCI?

    In complex multivessel disease with high SYNTAX scores, left main disease with high complexity, and diabetics with multivessel disease, CABG offers better long-term outcomes.

20. State the Ross procedure and its main indication.

    Replacement of a diseased aortic valve with the patient's own pulmonary valve (autograft), with a homograft placed in the pulmonary position; mainly used in young patients/children to allow growth and avoid anticoagulation.

21. Compare mechanical versus bioprosthetic heart valves regarding durability and anticoagulation.

    Mechanical valves are very durable but require lifelong warfarin anticoagulation; bioprosthetic valves avoid long-term anticoagulation but degenerate over ~10-15 years, favoring older patients.

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