Cardiac Surgery 19-23

 DNB NEET SS -  CTVS Questions

Questions 1-7            Questions 8-10                Questions 11-15

These are some questions asked in various entrance exams especially  DNB NEET SS

Q 19. 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

Q20. True statement about Mitral Stenosis is

a) It is always valvular in nature
b) Mitral regurgitation is uncommon when there is stenosis
c) Children should undergo mitral valve repair and not replacement
d) Surgery should be done after 18 years.

Q21.Which of the following is true regarding management for mitral valve disease 

a) Operation improves survival in severe symptomatic mitral valve disease
b) Tricuspid regurgitation is caused by defects above the leaflets
c) In mitral valve replacement mitral leaflets and chordae have to be resected
d) Medical therapy is indicated for mitral regurgitaion with left ventricular dilatation


Q22) Sign of 3 in Xray with rib notching is seen in 

a) Coarctation of Aorta

b) Tetrology of Fallot

c) Total Anamolous Pulmonary venous System

d) Severe MS

Q23 ) Most common ASD is 

a) Ostium Primum

b) Ostium Secundum

C) Sinus Venosus

d) All are equal


19) 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
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
           Normal leaflet motion
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

Mitral stenois can be Valvular, Supra valvular or sub valvular
Mitral regurgitation is common in the setting of mitral stenosis  and can be due to secondary annular dilation, congenital clefts of the valve and prolapse of the leaflets.
In children bioprosthetic valves should be avoided because of the need of life long anticoagulation. They should undergo mitral valve repair.

Surgery should not wait till adulthood because irreversible pulmonary hypertension can develop.

21. a
In mitral regurgitation, surgical therapy is indicated whenever there is left ventricular dilatation. Surgery is indicatd for severe MR.
Tricuspid regurgitation is due to leaflet abnormalities itself.

Mitral leaflets do not need to be resected and out of the two at least one has to be preserved.

22 a
Coarctation of Aorta
In this condition there is narrowing of lumen of aorta. 
Clinical features depend on the severity of narrowing and other associated conditions, It can be of two types
1. Infantile or pre ductal  Diffuse hypoplasia
2. Adult or Post ductal - Short segment abrupt stenosis
Features can be
1. Asymptomatic
2. Diminished femoral pulse
3. Radiofemoral delay
X ray shows 
1. Figure of 3 due to contour abnormality of aorta
2, Roesler sign Inferior rib notching  due to 
a) dilated intercostal vessels
For more read here

23 b

Common defects
Ostium secundum: fossa ovalis defect (approximately 70 per cent of ASDs)
Ostium primum: atrioventricular septal defect (approx imately 20 per cent of ASDs)
Sinus venosus defect: often associated with anomalous pulmonary venous drainage (approximately 10 per cent of ASDs)
Patent foramen ovale: common in isolation, usually no left-to-right shunt (not strictly an ASD)

Rarer defects
Inferior vena cava defects: a low sinus venosus defect and may allow shunting of blood into the left atrium
Coronary sinus septal defect: also known as unroofed coronary sinus with the left superior vena cava draining to the left atrium as part of a more complex lesion