Questions on Cardiac and Heart  Surgery
Examnation Questions in Surgery
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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