Rheumatic & Valvular Heart Disease, Cardiopulmonary Bypass (CPB), and Myocardial Protection — WACS Viva & Clinical Scenarios (Cardiothoracic)

Exam-style rheumatic & valvular heart disease, cardiopulmonary bypass (cpb), and myocardial protection viva scenarios with examiner probes and model answers…

Scenarios covered

• SCENARIO 1: A 28-year-old female (ASA IV E, 45 kg) with severe rheumatic mitral stenosis (mitral valve area 0.7 cm²), severe pulmonary hypertension (sPAP 75 mmHg), and chronic atrial fibrillation is scheduled for open mitral valve replacement on CPB. How do you formulate your anaesthetic management plan from induction to ICU transfer?
• SCENARIO 2: A 62-year-old male (ASA III, NYHA Class III) with severe calcific aortic stenosis (peak gradient 80 mmHg, valve area 0.6 cm², LVEF 40%) presents for elective mechanical aortic valve replacement. Detail your haemodynamic goals, induction strategy, and management of intraoperative hypotension.
• SCENARIO 3: A 34-year-old male undergoing double valve replacement (aortic and mitral) fails to wean from Cardiopulmonary Bypass despite high-dose epinephrine and milrinone infusions, exhibiting a mean arterial pressure of 40 mmHg and elevated left atrial pressures. Outline your step-by-step diagnostic and therapeutic troubleshooting approach.
• SCENARIO 4: A 22-year-old male with subacute bacterial endocarditis of the aortic valve complicated by severe aortic regurgitation, severe heart failure, and intermittent high-grade fever is posted for emergency aortic root reconstruction. How do you manage anaesthesia induction, CPB, and systemic sepsis considerations?