Q19. 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
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.
Q20. True statement about Mitral Stenosis
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
c) Mitral stenosis can be valvular, supravalvular, or subvalvular. Mitral regurgitation is common in mitral stenosis due to secondary annular dilation, congenital clefts, or leaflet prolapse. In children, bioprosthetic valves should be avoided; they should undergo repair. Surgery should not wait until adulthood to prevent irreversible pulmonary hypertension.
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 regurgitation with left ventricular dilatation
a) In mitral regurgitation, surgical therapy is indicated whenever there is left ventricular dilatation. Surgery is indicated for severe MR. Tricuspid regurgitation is due to leaflet abnormalities itself. Mitral leaflets do not need to be resected; at least one leaflet should be preserved.
Q22. Sign of 3 in X-ray with rib notching is seen in
a) Coarctation of Aorta
b) Tetrology of Fallot
c) Total Anomalous Pulmonary Venous System
d) Severe MS
a) Coarctation of Aorta. Narrowing of the aortic lumen causes asymptomatic cases, diminished femoral pulse, radiofemoral delay. X-ray shows figure of 3 due to contour abnormality and inferior rib notching due to dilated intercostal vessels. Read more: Radiopaedia.
Q23. Most common ASD is
a) Ostium Primum
b) Ostium Secundum
c) Sinus Venosus
d) All are equal
b) Ostium secundum is the most common ASD (≈70%). Ostium primum ≈20%, Sinus venosus ≈10%. Others like Patent Foramen Ovale and rarer defects exist but are less common.