Classifications in Cardiac Surgery

 

Carpentier Classification of MR

 

 

 

 

 

 

 

 

 

 Carpentier classification of MR based on leaflet mobility. 

Type 1: normal (annular dilation, leaflet perforation). Type 2: excessive (chordal or PM elongation or rupture) prolapse. 

Type3: restricted leaflet motion (comm fusion, leaflet thickening, chordal fusionor thickening) 3a valvular/subvalv thickening, 

3b PM displacement simple repairs commisurotomy +/- balloon (not if calc), quad resect, alfieri, annuloplast. 

Complex repairs, chordal transp, shortening,fenest, resect; artif chordae; leaflet repair; sliding tech; calc annulus.
   
CCS ANGINA CLASS
CCS 0
CCS I
CCS II
CCS III
CCS IV-A
CCS IV-B
CCS IV-C
CCS IV-D

 

 

 

 

 

 

 

 

 

 

 

 

 

 CCS 0 Asymptomatic.
CCS I Ordinary physical activity such as walking or climbing stairs does not cause angina. Angina with strenuous, rapid or prolonged exertion at work or recreation.
CCS II Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress, or during the few hours after awakening. Walking more than 2 blocks on the level and climbing more than one flight of stairs at a normal pace and in normal conditions.
CCS III Marked limitation of ordinary physical activity. Walking one or two blocks on the level or climbing one flight of stairs in normal conditions and at a normal pace.
CCS IV-A Inability to carry out any physical activity without discomfort -- anginal syndrome may be present at rest. Patient admitted to hospital and becomes relatively asymptomatic with aggressive medical therapy and may be managed on an outpatient basis.
CCS IV-B Inability to carry out any physical activity without discomfort -- anginal syndrome may be present at rest. Patient admitted to hospital and continues to experience angina on maximal medical therapy and cannot be safely discharged home, but does not require IV nitroglycerin.
CCS IV-C Inability to carry out any physical activity without discomfort -- anginal syndrome may be present at rest. Patient admitted to hospital and maximal medical therapy, including IV nitroglycerin, fails to control symptoms or there is hemodynamic instability.
CCS IV-D Shock.
   
CASS classification of LV 
1
2
3
4
5 
6 		 1 normal
2 moderate hypokinesia
3 severe hypokinesia
4 akinesia
5 dyskinesia
6 aneurysmal
   
Crawford classification
Type I
Type II
Type III

 

 

 

 Type I thoracoabdominal aneurysms are located from just below the subclavian artery down to above the celiac arteries. They are mainly within the chest itself. 
Type II are located just distal to the subclavian artery, extending down to and including all of the visceral arteries.
Type III start in the midthorax, extending down as far as the iliac arteries. Type IV are within the abdomen below the diaphragm.
   
Debakey classification
Type I
Type II
Type III
Type IIIa
Type IIIb

 

 

 

 Type I involves the ascending aorta, aortic arch, and descending aorta.
Type II is confined to the ascending aorta.
Type III is confined to the descending aorta distal to the left subclavian artery. 
Type IIIa refers to dissections that originate distal to the left subclavian artery but extend both proximally and distally, most above the diaphragm.
Type IIIb refers to dissections that originate distal to the left subclavian artery, extend only distally and may extend below the diaphragm. 
   
Grossman's criteria AR
1+
2+
3+
4+

 

 

 

 1+ Faint opacification of part (but not the whole) of the left ventricle, which clears each systole.
2+ Left ventricular opacification to a degree less than that in the aorta, but which does not clear with each beat.
3+ Left ventricular opacification equal to that of the aorta.
4+ Complete and dense left ventricular opacification in one beat with eventual density of contrast greater than that in the aorta.
   
Grossman's criteria MR
1+
2+
3+
4+

 

 

 

 1+ Faint opacification of part (but not all) of the left atrium, with clearing of contrast material with each beat.
2+ Opacification of the left atrium that does not clear with each beat, but that never equals that seen in the left ventricle.
3+ Opacification of the left atrium equal to that of the left ventricle.
4+ Complete opacification of the entire left atrium in one beat, progressive opacification of the left atrium with every beat, or reflux into the pulmonary veins.
   
Killip class
I
II
III
IV		 I--no evidence of heart failure
II--mild heart failure with limited rales
III--heart failure with more extensive rales
IV--cardiogenic shock with systolic blood pressure less than 90 mmHg.
   
Nagle's criteria MR
Grade I
Grade II
Grade III

 

 

 

 

 Grade I Mild mitral regurgitation is present when contrast medium does not opacify the entire atrium, which is small
Grade II moderate mitral regurgitation is diagnosed when visible jets enter the left atrium with every systolic beat (the grade of opacification depending on its dimension, i.e. the smaller the atrium, the more intensely opacified)
Grade III severe mitral regurgitation is when the contrast medium opacifies the entire left atrium, which is often enlarged, with a density equal to that of the left ventricle.
   
NYHA 
I
II
III
IV

 

 1 No symptoms with ordinary physical activity.
2 Symptoms with ordinary activity. Slight limitations of activity.
3 Symptoms with less than ordinary activity. Marked limitation of activity.
4 Symptoms with any physical activity or event at rest.
   
Pacemakers
1st Letter
2nd Letter
3rd Letter
4th Letter
5th Letter

 

 

 

 

 

 

 

 

 

 

 

 1st Letter The first letter refers to the chamber(s) paced: O(None), A(atrial), V(venticular), or D(both atrial and ventricular).
2nd Letter refers to the chamber(s) sensed: O(None), A(atrial), V(venticular), or D(both atrial and ventricular).
3rd Letter refers to the response to sensing(if any). This may be I (for inhibition) - a pacemakers discharge is inhibited (switched off) by the sensed signal. T (for triggering) - a pacemaker's discharge is triggered by a sensed signal.
4th Letter refers to the ability to change externally certain parameters of the permanent internal pacemaker. Possibilities are P simple programmability, an ability to change simple parameters, usually the rate and current output only. M multi-programmability, an ability to change more parameters. T or communicating, a telemetry function of the internal pacemaker. R or rate adaptive, the ability to vary the pacing rate through one or more physiological variables. Sensors include vibration, Q-T intervals, respiration, blood pH and right ventricular oxygen saturation.
5th Letter refers to the tachyarrhymic functions P for pacing tachycardias S for shocking, ability to DC shock ventricular tachycardia(VT) or fibrillation(VF). D for dual, offering both pacing and DC shock.3
   
Seller's criteria AR
1+
2+
3+
4+

 

 

 1+ Evidence of a jet of regurgitant contrast material without opacification of left ventricle.
2+ Evidence of a regurgitant jet with faint opacification of the left ventricle.
3+ Dense opacification of the left ventricle with no distinct jet usually visualised.
4+ The left ventricle is opacified more densely than the aorta.
   
Sellers' criteria MR
1+
2+
3+
4+

 

 

 

 

 1+ Minimal jetting that clears rapidly with each beat.
2+ Moderate opacification of the left atrium that clears with subsequent beats.
3+ Intense opacification of the left atrium on later films that equals that seen in the left ventricle and aorta. The radiopaque medium clears slowly from the left atrium. No jet is seen. The left atrium is usually, although not always, greatly enlarged.
4+ Intense opacification of the left atrium, denser than that of the left ventricle or aorta, often persisting over subsequent images. The left atrium is usually markedly enlarged and the left ventricle dilated.
   
Stanford classification
Type A
Type B		 Type A involves the ascending aorta (DeBakey types I and II). 
Type B does not (DeBakey type III).
   
TIMI flow
Grade 0
Grade 1
Grade 2
Grade 3

 

 

 Grade 0 No anterograde flow beyond point of occlusion
Grade 1 contrast goes beyond occlusion but fails to opacify the entire distal bed
Grade 2 entire vessel opacified, but the rate of entry to and clearance from the distal bed of the contrast is slower than normal
Grade 3 normal flow
   
Unstable angina

 

 

 

 

 

 

 Three presentations: Symptoms of angina at rest (usually prolonged >20 minutes), New onset (<2 months) exertional angina of at least Canadian Cardiovascular Society Classification (CCSC) class III in severity, or Recent (<2 months) acceleration of angina as reflected by an increase in severity of at least one CCSC class to at least CCSC class III. In most, but not all, of these patients, symptoms will be caused by significant coronary artery disease (CAD). Variant angina, non-Q-wave myocardial infarction (MI), and post-MI (>24 hours) angina are part of the spectrum of unstable angina.
   
Vaughn Williams

 

 

 

 Classification of Antiarrhythmic Agents 
Class Ia - Procainamide, Quinidine, Disopyramide;
Class Ib - Lidocaine, Mexiletine, Tocainide 
Class Ic Flecainide, Propafenone 
Class II - Propranolol, Esmolol 
Class III - Bretyllium, Amiodarone, Sotalol 
Class IV - Verapamil, Diltiazem
   
WHO performance status
Grade 0
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5

 

 

 

 Grade 0 Fully active, able to carry out all normal activity without restriction. 
1 Restricted in physically strenuous activity, but ambulatory and able to carry out work of a light or a sedentary. 
2 Ambulatory and capable of all self-care but unable to carry out any work, up and about more than 50% of the waking hours. 
3 Capable of only limited self-care, confined to bed or chair more than 50% of waking hours. 
4 Completely disabled; cannot carry out any self-care, totally confined to bed and chair. 
5 Dead