FCA(SA) Final Practice Questions - Fellowship Of The College Of Anaesthetists Of South Africa Final Examination Exam

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During cardiopulmonary bypass (CPB) weaning in a 58-year-old man after mitral valve replacement, the perfusionist reports rising left atrial pressure, falling cardiac output, and a new holosystolic murmur. TEE shows severe mitral regurgitation with a flail posterior leaflet. What is the most appropriate immediate management?

Increase inotropic support and proceed with planned separation from CPB Return to full CPB, reassess repair, and consider re-exploration for leaflet prolapse Administer intravenous nitroglycerin infusion to reduce afterload Extubate early to reduce intrathoracic pressure on the left atrium

Correct Answer:

Return to full CPB, reassess repair, and consider re-exploration for leaflet prolapse

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