Cardiac Surgery Certification Exam Cardiac Valve Surgery 1 — Questions and Answers
Question 1: The standard surgical approach for isolated mitral valve surgery in most US centers is:
- Median sternotomy with left atriotomy via the interatrial groove (Correct answer)
- Left thoracotomy
- Right minithoracotomy only
- Subxiphoid approach
Correct answer: Median sternotomy with left atriotomy via the interatrial groove
Median sternotomy with access through the left atrium via the interatrial (Sondergaard) groove is the standard approach for most mitral valve operations.
Question 2: Which feature of a bioprosthetic heart valve is its primary advantage over a mechanical valve?
- Does not require lifelong anticoagulation (Correct answer)
- Greater durability beyond 20 years
- Lower cost
- Easier to implant
Correct answer: Does not require lifelong anticoagulation
Bioprosthetic valves do not require long-term anticoagulation after the initial postoperative period, reducing hemorrhagic risks for appropriate patients.
Question 3: The most common cause of mitral valve regurgitation requiring surgery in the United States is:
- Myxomatous mitral valve disease (mitral valve prolapse) (Correct answer)
- Rheumatic heart disease
- Infective endocarditis
- Ischemic papillary muscle rupture
Correct answer: Myxomatous mitral valve disease (mitral valve prolapse)
Myxomatous degeneration (Barlow's disease or fibro-elastic deficiency) causing mitral valve prolapse is the leading cause of surgical mitral regurgitation in the US.
Question 4: What is the preferred surgical option for mitral regurgitation due to posterior leaflet prolapse with good tissue quality?
- Mitral valve repair (Correct answer)
- Mechanical valve replacement
- Bioprosthetic valve replacement
- Transcatheter edge-to-edge repair
Correct answer: Mitral valve repair
Mitral valve repair is the gold standard for posterior leaflet prolapse because it preserves native tissue, avoids prosthetic valve risks, and provides excellent long-term outcomes.
Question 5: The annuloplasty ring used in mitral valve repair serves primarily to:
- Remodel and stabilize the mitral annulus to prevent recurrent regurgitation (Correct answer)
- Increase valve orifice area
- Replace the posterior leaflet
- Prevent leaflet prolapse directly
Correct answer: Remodel and stabilize the mitral annulus to prevent recurrent regurgitation
The annuloplasty ring reshapes and downsizes the dilated mitral annulus, ensuring leaflet coaptation and long-term repair durability.
Question 6: Intraoperative TEE after mitral valve repair is used primarily to:
- Assess residual regurgitation and confirm adequate valve function before chest closure (Correct answer)
- Guide cardioplegia delivery
- Monitor pulmonary pressures only
- Determine when to initiate bypass
Correct answer: Assess residual regurgitation and confirm adequate valve function before chest closure
Post-repair TEE immediately identifies residual or new regurgitation, stenosis, or systolic anterior motion, allowing the surgeon to revise the repair before leaving the OR.
Cardiac Surgery Certification Exam Cardiac Valve Surgery 1
The standard surgical approach for isolated mitral valve surgery in most US centers is: