ACCSAP Valvular Disease Flashcards
When do you consider surgical repair in a patient with BAV and aortopathy?
when the aortic size is >5.5 cm, there is rapidly increasing size (>0.5 cm/year), or a family history of dissection (Class IIa).
What do you expect to see on echo for prosthetic aortic valve stenosis?
Expected findings would be an elevated transvalvular velocity and gradient; a prolonged (>100 msec) acceleration time; a reduced effective orifice area (<1 cm2); and a reduced dimensionless index (<0.3).
acceleration time is usually ≤100 msec in PPM, whereas it is >100 msec with pathologic obstruction.
PPM will typically have a DVI >0.25, whereas in pathological obstruction it will be <0.25
What is AC recommendation for bileaflet mechanical AVR and no other risk factors for thrombosis who are undergoing invasive or surgical procedures?
Temporary interruption of vitamin K antagonist (VKA) anticoagulation, without bridging agents while the interantional normalized ratio (INR) is subtherapeutic.
What are indications for bridging therapy during interruption of AC in valvular prostheses?
higher-risk patients, such as those with a mechanical mitral valve replacement or AVR and additional risk factors for thromboembolism (e.g., atrial fibrillation, previous thromboembolism, hypercoagulable condition, older-generation mechanical valves [ball-cage or tilting disc], left ventricular systolic dysfunction, or >1 mechanical valve).
Endocarditis prophylaxis is only recommended for conditions associated with the highest risk of adverse outcome from endocarditis. What are they?
prosthetic cardiac valve or prosthetic valve repair material, prior history of infective endocarditis, cardiac transplant recipients with valvulopathy, completely repaired congenital heart disease (CHD) with percutaneous or surgical repair occurring within the previous 6 months, repaired CHD with residual shunts or defects that impair endothelialization of prosthetic material, and unrepaired cyanotic CHD.
echocardiographic characteristics of Ebstein’s anomaly?
congenital disease characterized by apical displacement of the tricuspid valve septal and posterior leaflets from the atrioventricular ring. The septal and posterior leaflets are typically adherent to the underlying myocardium with an apical displacement of ≥8 mm/m2 compared with the mitral valve annulus
What is appropriate screening interval for asymptomatic AS and normal LVEF?
Pk velocity >4.0 m/s
Ptk velocity 3.0-3.9 m/s
Pk velocity 2.0-2.9 m/s
Pk velocity >4.0 m/s –> 6 months to 1 yr
Ptk velocity 3.0-3.9 m/s –> Every 1-2 years
Pk velocity 2.0-2.9 m/s –> Every 3–5 years
For patients with a BAV and an ascending aortic aneurysm >4.5 cm, what is the interval recommended for imaging?
Annually.
Exam and echo findings in a pt with bicuspid aortic valve?
Bicuspid aortic valve can be associated with sudden cessation of valve opening, leading to an ejection systolic click, and often is associated with significant aortic valve regurgitation. Findings of chronic aortic regurgitation with left ventricular volume overload include an enlarged and laterally displaced apical pulse, wide aortic pulse pressure, and an S3.
What is recommendation for secondary rheumatic fever prophylaxis?
1) With residual valvular disease, the recommended duration is to continue penicillin prophylaxis for 10 years from the last episode of acute rheumatic fever or until the age of 40.
2) If there was acute carditis, but no residual valve disease, the recommendation is for 10 years or until age 21 (whichever is longer).
3) If there was rheumatic fever without carditis, the recommendation is for 5 years or until the age of 21 (whichever is longer).
Treatment includes oral penicillin V twice daily, monthly benzathine penicillin G intramuscular injection, or daily sulfadiazine.
Is there a safe dose of warfarin to use in pregnancy?
Yes, if the dose is less than 5 mg daily.
a Class IIa (Level of Evidence B) recommendation that those patients on ≤5 mg/day of warfarin may safely remain on warfarin the entire pregnancy, changing to UFH just prior to delivery.
Is there a safe dose of warfarin to use in pregnancy?
Yes, if the dose is less than 5 mg daily.
a Class IIa (Level of Evidence B) recommendation that those patients on ≤5 mg/day of warfarin may safely remain on warfarin the entire pregnancy, changing to UFH just prior to delivery.
IF DOSE IS >5mg/day, warfarin should be discontinued for the first trimester and either UFH (with measured activated partial thromboplastin time of more than twofold control) or low molecular wieght heparin (LMWH; with measured anti-Xa of 0.8-1.2 U/ml 4-6 hours postdose) may be used. Weight-based dosing of UFH and LMWH does not provide adequate anticoagulant effect in many cases because of the increased volume of distribution that occurs during pregnancy. Warfarin then can be reinstituted for the second and third trimester and stopped just prior to delivery and replaced with UFH.
Once a diagnosis of severe symptomatic MS is madde based on TTE, what is the next diagnostic test needed prior to percutaneous mitral balloon commissurotomy?
TEE to assess the presence or absence of left atrial thrombus and to further evaluate the severity of MR.
Can be done only if mild MR or less.
Pts CTA shows aortic root of 4.2 cm (mildly enlarged). What is the next step in mgmt?
TTE!
Patients with dilation of the aortic root or ascending thoracic aorta should be evaluated for bicuspid aortic valve and/or aortic regurgitation with transthoracic echocardiography.
