ACC Valvular Disease

Question 0

Name the echo parameters to classify moderate aortic stenosis.

Answer 0

For moderate disease…

1. Peak jet velocity greater than 3-4 m/s.
2. Mean gradient 25-40 mmHg.
3. Aortic valve area 1-1.5cm².

Question 1

Name the echo parameters to classify severe aortic stenosis.

Answer 1

For severe disease…

1. Peak jet velocity greater than 4 m/s.
2. Mean gradient greater than 40 mmHg.
3. Aortic valve area less than 1 cm².
4. Valve area index > 0.6 cm²/m²

Question 2

Name the Echo parameters for severe Mitral valve stenosis:

Answer 2

1. Transvalvular gradient of >10mmHg
2. Pulmonary artery systolic pressure > 50 mmHg.
3. Mitral valve area less than 1 cm²

Question 3

Name the qualitative assessment (angiographic and Doppler) criteria for mitral regurgitation.

Answer 3

1. Angiographic: grade 1+ for mild, 2+ plus for moderate, 3 to 4+ for severe.
2. Color Doppler: Mild = < 25% of regurgitant jet in the LA area. Severe = greater than 40% of regurgitant jet in the LA area, Or wall impinging jet of any size, swirling in LA.
3. Vena contracta width: Mild < 0.3 cm, Severe >0.7 cm

In addition, left atrial and ventricular enlargement a required to classify as severe disease.

Question 4

Name the quantitative criteria for mitral regurgitation grade.

Answer 4

1. Regurgitant volume: Mild = less than 30 mL per beat; Severe = >60 mL per beat.
2. Regurgitant fraction: mild = less than 30% per beat. Severe = >50% per beat.
3. Regurgitate orifice: mild = less than 0.2 cm²; severe = >0.4 cm²

Left atrial and left ventricular enlargement must be present to classify as severe disease.

Question 5

Name the qualitative criteria for angiographic and Doppler assessment of aortic regurgitation.

Answer 5

1 angiographic assessment: grade 1 mild, grade 3-4 severe.

2. Color Doppler regurgitant CENTRAL jet LVOT: 65% = severe.

Question 6

Name the recommendation for endocarditis prophylaxis for dental procedures.

Answer 6

Class 2A recommendation
1) patients with a prosthetic heart valve or prosthetic material
used for valve repair.
2) patients with a past history of infective endocarditis.
3) patients with cardiac valvulopathy following cardiac transplantation.
4) specific patients with Congenital heart disease: unrepaired cyanotic heart disease including palliative shunts, completely repaired disease within the last six months, repaired disease with residual defects at or near the site.

Question 7

Name the quantitative criteria for aortic regurgitation.

Answer 7

1. Regurgitant volume: Mild = 60mL.
2. Regurgitant fraction: Mild = 50%.
3. Regurgitant orifice: Mild = < 0.10 cm²; severe = > 0.40 cm².

Left ventricular size is required to be increased to be considered severe.

Question 8

What are the indications for rheumatic fever prophylaxis?

Answer 8

Anyone who is had rheumatic fever with or without carditis should receive prophylaxis for recurrent rheumatic fever.

Question 9

A patient has rheumatic fever with carditis and residual heart disease (Persistent valvular disease). What is the duration of antibiotic prophylaxis this patient should receive?

Answer 9

10 y or greater since last episode and at least until age 40 y; sometimes lifelong prophylaxis*

Question 10

A patient has had Rheumatic fever with carditis but no residual heart disease (no valvular disease). How long should they be on antibiotic prophylaxis?

Answer 10

10 y or well into adulthood, whichever is longer.

Question 11

The patient has had rheumatic fever without carditis. How long should they receive antibiotic prophylaxis?

Answer 11

Five years or until age 21; whichever is longer.

Question 12

When might you have a severely stenotic aortic valve with a normal transvalvular gradient?

Answer 12

When cardiac output is reduced.