CSC (CARDIAC SURGERY CERTIFICATION) FINAL EXAM
2026/2027 PRACTICE QUESTIONS COMPLETE ACCURATE
EXAM APPROVED QUESTIONS WITH WELL ELABORATED
ANSWERS AND DETAILED RATIONALES (RELIABLE
SOLUTIONS) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED SUCCESS A+ |FULL REVISED
CSC (CARDIAC SURGERY CERTIFICATION) APPROVED
FINAL EXAM |INSTANT DOWNLOAD PDF
1. A 68-year-old male with a history of hypertension and diabetes
presents with progressive dyspnea on exertion and angina.
Echocardiography reveals severe aortic stenosis with a mean
gradient of 55 mmHg and an aortic valve area of 0.7 cm². Coronary
angiography shows 70% stenosis of the left anterior descending
artery. Which of the following is the most appropriate surgical
strategy?
A. Isolated surgical aortic valve replacement (SAVR)
B. Transcatheter aortic valve replacement (TAVR) with
percutaneous coronary intervention
C. CORRECT ANSWER: SAVR with concomitant coronary artery
bypass grafting (CABG)
D. Medical management with optimization of antianginal therapy
,Rationale: The patient has severe symptomatic aortic stenosis with
coexisting significant coronary artery disease. Current guidelines
recommend surgical aortic valve replacement with concomitant
CABG for patients with severe aortic stenosis and significant
coronary artery disease who are surgical candidates . This approach
addresses both the valvular and coronary pathology simultaneously,
reducing the need for future reinterventions. Isolated SAVR would
leave the LAD stenosis unaddressed, increasing perioperative and
long-term risk of myocardial ischemia. TAVR with PCI is an
alternative for high-risk or inoperable patients, but this patient's
presentation and overall risk profile favor a surgical approach with
revascularization.
2. A 45-year-old female undergoes mitral valve repair for severe
mitral regurgitation due to myxomatous degeneration. Post-bypass
transesophageal echocardiography (TEE) reveals a residual mild
central mitral regurgitation with a stable mean gradient of 4 mmHg.
What is the appropriate next step in management?
A. Return to cardiopulmonary bypass for immediate re-repair
B. CORRECT ANSWER: Accept the result and close the chest
C. Perform a mitral valve replacement
D. Administer intravenous nitroglycerin to reduce afterload
Rationale: A residual mild (1+) central mitral regurgitation after
mitral valve repair with an acceptable mean gradient is generally
,considered an acceptable result . The goal of mitral valve repair is to
achieve a competent valve without significant stenosis. Mild residual
regurgitation is often well-tolerated and may improve with
postoperative left ventricular remodeling. Immediate re-repair is
reserved for moderate or severe residual regurgitation or mitral
stenosis. Replacing a successfully repaired valve would be overly
aggressive. Nitroglycerin may reduce afterload but does not address
the structural issue of the repair.
3. A 72-year-old male with severe aortic stenosis undergoes TAVR
via transfemoral approach. During balloon valvuloplasty, the patient
develops acute hypotension and bradycardia. TEE shows a new
moderate pericardial effusion with right ventricular collapse. What is
the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. CORRECT ANSWER: Pericardial tamponade due to ventricular
perforation
D. Anaphylactic reaction to contrast media
Rationale: Acute pericardial tamponade is a known complication of
TAVR, particularly during balloon valvuloplasty or valve
deployment . The wire or balloon can perforate the right ventricle,
leading to pericardial effusion and subsequent tamponade. The
clinical presentation of hypotension, bradycardia, and right
, ventricular collapse on TEE is classic for tamponade. Myocardial
infarction would present with ST-segment changes and wall motion
abnormalities. Aortic dissection would be characterized by a tear in
the aorta on imaging. Anaphylaxis would present with
bronchospasm and rash, not pericardial effusion.
4. A 60-year-old male presents with acute type A aortic dissection.
He has severe aortic regurgitation, pericardial effusion, and a tear in
the ascending aorta just above the sinotubular junction. Which of the
following is the most appropriate surgical procedure?
A. Bentall procedure
B. CORRECT ANSWER: Ascending aortic replacement with aortic
valve resuspension
C. Wheat procedure
D. David procedure
Rationale: For an acute type A aortic dissection with a tear in the
ascending aorta and associated aortic regurgitation, the
recommended surgical approach is often ascending aortic
replacement with resuspension of the aortic valve if the valve leaflets
are structurally normal . Resuspension can effectively restore aortic
valve competence without replacing the valve. The Bentall procedure
is indicated when the aortic root is involved or the valve is diseased.
The Wheat procedure involves replacement of the ascending aorta
and aortic valve, but preservation of the sinuses. The David
2026/2027 PRACTICE QUESTIONS COMPLETE ACCURATE
EXAM APPROVED QUESTIONS WITH WELL ELABORATED
ANSWERS AND DETAILED RATIONALES (RELIABLE
SOLUTIONS) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED SUCCESS A+ |FULL REVISED
CSC (CARDIAC SURGERY CERTIFICATION) APPROVED
FINAL EXAM |INSTANT DOWNLOAD PDF
1. A 68-year-old male with a history of hypertension and diabetes
presents with progressive dyspnea on exertion and angina.
Echocardiography reveals severe aortic stenosis with a mean
gradient of 55 mmHg and an aortic valve area of 0.7 cm². Coronary
angiography shows 70% stenosis of the left anterior descending
artery. Which of the following is the most appropriate surgical
strategy?
A. Isolated surgical aortic valve replacement (SAVR)
B. Transcatheter aortic valve replacement (TAVR) with
percutaneous coronary intervention
C. CORRECT ANSWER: SAVR with concomitant coronary artery
bypass grafting (CABG)
D. Medical management with optimization of antianginal therapy
,Rationale: The patient has severe symptomatic aortic stenosis with
coexisting significant coronary artery disease. Current guidelines
recommend surgical aortic valve replacement with concomitant
CABG for patients with severe aortic stenosis and significant
coronary artery disease who are surgical candidates . This approach
addresses both the valvular and coronary pathology simultaneously,
reducing the need for future reinterventions. Isolated SAVR would
leave the LAD stenosis unaddressed, increasing perioperative and
long-term risk of myocardial ischemia. TAVR with PCI is an
alternative for high-risk or inoperable patients, but this patient's
presentation and overall risk profile favor a surgical approach with
revascularization.
2. A 45-year-old female undergoes mitral valve repair for severe
mitral regurgitation due to myxomatous degeneration. Post-bypass
transesophageal echocardiography (TEE) reveals a residual mild
central mitral regurgitation with a stable mean gradient of 4 mmHg.
What is the appropriate next step in management?
A. Return to cardiopulmonary bypass for immediate re-repair
B. CORRECT ANSWER: Accept the result and close the chest
C. Perform a mitral valve replacement
D. Administer intravenous nitroglycerin to reduce afterload
Rationale: A residual mild (1+) central mitral regurgitation after
mitral valve repair with an acceptable mean gradient is generally
,considered an acceptable result . The goal of mitral valve repair is to
achieve a competent valve without significant stenosis. Mild residual
regurgitation is often well-tolerated and may improve with
postoperative left ventricular remodeling. Immediate re-repair is
reserved for moderate or severe residual regurgitation or mitral
stenosis. Replacing a successfully repaired valve would be overly
aggressive. Nitroglycerin may reduce afterload but does not address
the structural issue of the repair.
3. A 72-year-old male with severe aortic stenosis undergoes TAVR
via transfemoral approach. During balloon valvuloplasty, the patient
develops acute hypotension and bradycardia. TEE shows a new
moderate pericardial effusion with right ventricular collapse. What is
the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. CORRECT ANSWER: Pericardial tamponade due to ventricular
perforation
D. Anaphylactic reaction to contrast media
Rationale: Acute pericardial tamponade is a known complication of
TAVR, particularly during balloon valvuloplasty or valve
deployment . The wire or balloon can perforate the right ventricle,
leading to pericardial effusion and subsequent tamponade. The
clinical presentation of hypotension, bradycardia, and right
, ventricular collapse on TEE is classic for tamponade. Myocardial
infarction would present with ST-segment changes and wall motion
abnormalities. Aortic dissection would be characterized by a tear in
the aorta on imaging. Anaphylaxis would present with
bronchospasm and rash, not pericardial effusion.
4. A 60-year-old male presents with acute type A aortic dissection.
He has severe aortic regurgitation, pericardial effusion, and a tear in
the ascending aorta just above the sinotubular junction. Which of the
following is the most appropriate surgical procedure?
A. Bentall procedure
B. CORRECT ANSWER: Ascending aortic replacement with aortic
valve resuspension
C. Wheat procedure
D. David procedure
Rationale: For an acute type A aortic dissection with a tear in the
ascending aorta and associated aortic regurgitation, the
recommended surgical approach is often ascending aortic
replacement with resuspension of the aortic valve if the valve leaflets
are structurally normal . Resuspension can effectively restore aortic
valve competence without replacing the valve. The Bentall procedure
is indicated when the aortic root is involved or the valve is diseased.
The Wheat procedure involves replacement of the ascending aorta
and aortic valve, but preservation of the sinuses. The David
