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Question 1

In what views are you seeing the A2, P2 leaflets?

Question 2

What are the abnormalities you see in Ebstein’s anomaly?

Answer 2

1) Long anterior tricuspid valve leaflet
2) Short septal tricuspid valve leaflet
3) Leaflet closure is well into the ventricle causing significant atrialiasation of the RV
4) Tethering of the anterior tricuspid valve leaflet to the myocardium
5) Frequent association with ASDs, accessory pathways (less so VSDs, CoA, PDA)

Question 3

In volume overload (severe TR) is the septum flat in diastole or systole

Answer 3

Diastole

Question 4

In pressure overload (pulmonary hypertension) is the septum flat in systole or diastole

Answer 4

systole

Question 5

If there is septal flattening in systole and diastole then that means there is

Answer 5

pressure and volume overload

Question 6

How can you calculate tricuspid valve area in suspected TS

Answer 6

TVA = 190/PHT

Question 7

What is severe TS

Answer 7

TVA <1cm2, mean gradient >5 mmHg

Question 8

The definition of patient prosthesis mismatch is…

Answer 8

indexed effective orifice area < 0.85 cm2/m2

Question 9

If the gradient across a prosthetic mitral valve is elevated but the PHT is normal, what does that mean?

Answer 9

Significant regurgitation

If the PHT was elevated, then it would mean obstruction

Question 10

Which patients are at high risk for endocarditis and should receive antibiotic prophylaxis?

Answer 10

Those with:
previous endocarditis
Prosthetic valves
Untreated cyanotic congenital heart disease or those treated with postoperative palliative shunts or other prosthesis
VAD destination therapy

Antibiotic prophylaxis should also be given immediately following
transcatheter tAVR or tMVR

Question 11

Would a fibroelastoma on the aortic valve be associated with AR?

Answer 11

Generally, no. Fibroelastomas, unlike vegetations, do not disrupt the valve itself.

Question 12

When evaluating tricuspid valve endocarditis, what else should you always look for?

Answer 12

PFO or ASD as this can lead to paradoxical embolism

Question 13

What are the indications for surgery in TVE?

Answer 13

Persistent bacteraemia > 7 days despite treatment
Persistent TV vegetations > 20mm after recurrent PEs
Right heart failure, severe TR (non responsive to diuretics)
Respiratory insufficiency requiring ventilatory support with persistent vegetations causing recurrent PEs
Left heart structures also involved