Q 11. Structures which may be injured in mitral valve replacement are all except
A) Circumflex coronary artery
B) Right coronary artery
C) Aortic valve
D) AV node
Answers
11) B
While sewing the valve the sutures are taken accurately in the annulus because there is a risk of injuring
Left circumflex artery at 7-8 o clock
AV node at 1-2 o clock
Aortic valve at 10-12 o clock
notes
Indications of surgery for mitral stenosis
1. Symptomatic patient with mitral valve area less than 1.5 m2
2. Mitral valve area less than 1 m2
3. Embolisation
4. Pulmonary hypertension
5. Increased transvalvular graduent on exercise echocardiography
Mitral insufficiency
Carpentier Classification
Type I annular dilatation
Leaflet perforation
Normal leaflet motion
TypeII. Degenerative diseases
Leaflet prolapse
Ruptured chordae
Increased leaflet motion
Valve has a billowing appearance
TypeIII rheumatic heart diseases
Restricted leaflet motion
Indications of surgery
1. Symptomatic patient
2. Asymptomatic patient with severe mitral insufficiency
3. Decreased ejection fraction
4. Pulmonary hypertension
5. Atrial fibrillation
6. Abnormal stress echo
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