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oral boards > AHA: MR > Flashcards

AHA: MR Flashcards

1
Q

bp v mech

class 1 recommendation(s) for mitral valve choice

A
  • shared decision-making (1)
  • bp if warfarin contraindicated (1)

“For patients who require heart valve replacement, the choice of prosthetic valve should be based on a shared decision-making process that accounts for the patient’s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risks associated with valve reintervention.”
“For patients of any age requiring valve replacement for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired, a bioprosthetic valve is recommended.”

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2
Q

bp v mech

class 1 recommendation(s) for mitral valve choice

(2)

A
  • shared decision-making (1)
  • bp if warfarin contraindicated (1)

“For patients who require heart valve replacement, the choice of prosthetic valve should be based on a shared decision-making process that accounts for the patient’s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risks associated with valve reintervention.”
“For patients of any age requiring valve replacement for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired, a bioprosthetic valve is recommended.”

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3
Q

bp v mech

age-based recommendation(s) for mitral valve choice

A
  • <65yo = mech (2a)
  • ≥65yo = bp (2a)

assuming no contraindication to warfarin

“For patients <65 years of age who have an indication for MVR, do not have a contraindication to anticoagulation, and are unable to undergo MVRx, it is reasonable to choose a mechanical prosthesis over a bioprosthetic valve.”
“For patients ≥65 years of age who require MVR and are unable to undergo MVRx, it is reasonable to choose a bioprosthesis over a mechanical valve.”

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4
Q

bp v mech

mitral valve choice if warfarin contraindicated

A

bp (1)

“For patients who require heart valve replacement, the choice of prosthetic valve should be based on a shared decision-making process that accounts for the patient’s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risks associated with valve reintervention.”
“For patients of any age requiring valve replacement for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired, a bioprosthetic valve is recommended.”

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5
Q

bp v mech

mitral valve choice in <65yo

assuming no contraindication to warfarin

A

mech
(2a)

“For patients <65 years of age who have an indication for MVR, do not have a contraindication to anticoagulation, and are unable to undergo MVRx, it is reasonable to choose a mechanical prosthesis over a bioprosthetic valve.”
“For patients ≥65 years of age who require MVR and are unable to undergo MVRx, it is reasonable to choose a bioprosthesis over a mechanical valve.”

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6
Q

bp v mech

mitral valve choice in ≥65yo

assuming no contraindication to warfarin

A

bp
(2a)

“For patients <65 years of age who have an indication for MVR, do not have a contraindication to anticoagulation, and are unable to undergo MVRx, it is reasonable to choose a mechanical prosthesis over a bioprosthetic valve.”
“For patients ≥65 years of age who require MVR and are unable to undergo MVRx, it is reasonable to choose a bioprosthesis over a mechanical valve.”

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7
Q

regurgitant jet width (% of LA) in mild MR

A

<20

%

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8
Q

vena contracta in mild MR

A

<0.3

cm

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9
Q

RVol/Vregurg in mild MR

regurgitant volume

A

<30

mL/beat

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10
Q

RF in mild MR

regurgitant fraction

A

<30

%

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11
Q

EROA in mild MR

effective regurgitant orifice area

A

<0.2

cm2

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12
Q

grade in mild MR

A

1+

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13
Q

PV flow reversal in mild MR

A

systolic dominance

only specified in ASE

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14
Q

regurgitant jet width (% of LA) in moderate MR

A

20-40

%

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15
Q

vena contracta in moderate MR

A

0.3-0.7

cm

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16
Q

RVol/Vregurg in moderate MR

regurgitant volume

A

30-60

mL/beat

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17
Q

RF in moderate MR

regurgitant fraction

A

30-50

%

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18
Q

EROA in moderate MR

effective regurgitant orifice area

A

0.2-0.4

cm2

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19
Q

grade in moderate MR

A

2+

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20
Q

PV flow reversal in moderate MR

A

systolic blunting

only specified in ASE

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21
Q

regurgitant jet width (% of LA) in severe MR

A

>40

%

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22
Q

vena contracta in severe MR

A

≥0.7

cm

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23
Q

RVol/Vregurg in severe MR

regurgitant volume

A

≥60

mL/beat

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24
Q

RF in severe MR

regurgitant fraction

A

≥50

%

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25
Q

EROA in severe MR

effective regurgitant orifice area

A

≥0.4

cm2

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26
Q

grade in severe MR

A

3-4+

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27
Q

PV flow reversal in severe MR

A

holosystolic

only specified in ASE

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28
Q

mitral valve

regurgitant jet width (% of LA) <20 %

A

mild MR

29
Q

mitral valve

vena contracta <0.3 cm

A

mild MR

30
Q

mitral valve

RVol/Vregurg <30 mL/beat

regurgitant volume

A

mild MR

31
Q

mitral valve

RF <30 %

regurgitant fraction

A

mild MR

32
Q

mitral valve

EROA <0.2 cm2

effective regurgitant orifice area

A

mild MR

33
Q

mitral valve

1+ grade regurg

A

mild MR

34
Q

mitral valve

regurgitant jet width (% of LA) = 20-40 %

A

moderate MR

35
Q

mitral valve

vena contracta = 0.3-0.7 cm

A

moderate MR

36
Q

mitral valve

RVol/Vregurg = 30-60 mL/beat

regurgitant volume

A

moderate MR

37
Q

mitral valve

RF = 30-50 %

regurgitant fraction

A

moderate MR

38
Q

mitral valve

EROA = 0.2-0.4 cm2

effective regurgitant orifice area

A

moderate MR

39
Q

mitral valve

2+ grade regurg

A

moderate MR

40
Q

mitral valve

regurgitant jet width (% of LA) >40 %

A

severe MR

41
Q

mitral valve

vena contracta ≥0.7 cm

A

severe MR

42
Q

mitral valve

RVol/Vregurg ≥60 mL/beat

regurgitant volume

A

severe MR

43
Q

mitral valve

RF ≥50 %

regurgitant fraction

A

severe MR

44
Q

mitral valve

EROA ≥0.4 cm2

effective regurgitant orifice area

A

severe MR

45
Q

mitral valve

3-4+ grade regurg

A

severe MR

46
Q

indication(s) for intervention in moderate 1° MR

A

NONE
regardless of sx status

47
Q

indication(s) for intervention in moderate 2° MR

A

NONE
regardless of sx status

48
Q

indication(s) for intervention in moderate MR

A

NONE
regardless of sx status

neither 1° nor 2°

49
Q

indication(s) for intervention in severe 2° MR

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
  • sx (NYHA ≥II) ⊕GDMT + MR r/t LVEF<50% AND EF>20% + LVESD≤70mm + PASP≤70mmHg ⇒ TEER (2a)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LVEF<50% ⇒ MVR/x (2b)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LA annular dil + LVEF≥50% ⇒ MVR/x (2b)
50
Q

indication(s) for intervention in sx severe 2° MR

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
  • sx (NYHA ≥II) ⊕GDMT + MR r/t LVEF<50% AND EF>20% + LVESD≤70mm + PASP≤70mmHg ⇒ TEER (2a)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LVEF<50% ⇒ MVR/x (2b)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LA annular dil + LVEF≥50% ⇒ MVR/x (2b)
51
Q

indication(s) for intervention in sx severe 2° MR

(4)

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
  • sx (NYHA ≥II) ⊕GDMT + MR r/t LVEF<50% AND EF>20% + LVESD≤70mm + PASP≤70mmHg ⇒ TEER (2a)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LVEF<50% ⇒ MVR/x (2b)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LA annular dil + LVEF≥50% ⇒ MVR/x (2b)
52
Q

indication(s) for intervention in asx severe 2° MR

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
53
Q

ONLY indication for intervention in asx severe 2° MR

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
54
Q

indication(s) for surgical intervention in sx severe 2° MR

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LVEF<50% ⇒ MVR/x (2b)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LA annular dil + LVEF≥50% ⇒ MVR/x (2b)
55
Q

indication(s) for surgical intervention in sx severe 2° MR

(3)

A
  • concomitant CABG ⇒ MVR/x (2a)
    regardless of sx status
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LVEF<50% ⇒ MVR/x (2b)
  • v sx (NYHA ≥III) ⊕GDMT + MR r/t LA annular dil + LVEF≥50% ⇒ MVR/x (2b)
56
Q

indication(s) for transcatheter intervention in sx severe 2° MR

A
  • sx (NYHA ≥II) ⊕GDMT + MR r/t LVEF<50% AND EF>20% + LVESD≤70mm + PASP≤70mmHg ⇒ TEER (2a)
57
Q

indication(s) for transcatheter intervention in sx severe 2° MR

(1)

A
  • sx (NYHA ≥II) ⊕GDMT + MR r/t LVEF<50% AND EF>20% + LVESD≤70mm + PASP≤70mmHg ⇒ TEER (2a)
58
Q

preferred surgical intervention in 2° MR

A

chordal-sparing MVR (>MVRx)
(2b)

59
Q

preferred surgical intervention in 1° MR

A

MVRx (>MVR) in degen dz
(1)

60
Q

indication(s) for intervention in severe 1° MR

A
  • sx (regardless of EF) (1)
  • v sx (NYHA ≥III) + high/prohib-risk ⇒ TEER (2a)
  • rheumatic etio & rx likely @ CVC ⇒ MVR/x (2b)
  • asx + LV dysfxn (EF≤60% OR LVESD≥40mm) (1)
  • asx + EF=WNL AND >95% rx & <1% mort @ CVC (2a)
  • asx + EF=WNL BUT progressive ￬ EF OR ↑ LVESD on 3 studies (2b)
61
Q

CTSNet severe ischemic MR trial: primary endpoint

A

LVESD volume index (i.e. LV remodeling)
⇒∅

62
Q

CTSNet severe ischemic MR trial: outcomes

A

￬HF SAEs (incl re-adm) & ￬mod+MR with replacement

63
Q

2° severe MR feature/anatomy most predictive of recurrent MR after MVRx

A

basal inferior dyskinesis
(in post-hoc analysis of CTSNet severe MR trial; SESATS)

64
Q

preferred ring/band choice for a MVRx for 2° MR

A

complete (slightly undersized) ring
(still semi-rigid?)

65
Q

pulmonary edema laterality 2/2 mitral dz

A

R
2/2 flow reversal into PVs during systole, with relative obstr to R-sided pulm venous return, with retrograde increase in hydrostatic pressure

66
Q

mgmt of acute MR 2/2 chordal rupture

A

emergent MVRx (usu not 2/2 MI)

67
Q

unilateral R pulm edema, fever, leukocytosis, acute onset, +systolic murmur

A

acute MR 2/2 chordal rupture

68
Q

Where & what structures are at risk around the mitral annulus?

A
  1. LCx @ P1 > anterolat commissure
  2. NCC @ anterior leaflet (A3)
    (>>LCC@A1)
  3. coronary sinus @ posterior leaflet P3>P2
  • ± bundle of His @ A3/posteromed commissure (next to R trigone in membranous septum)
69
Q

What are the 2 papillary muscles and their blood supply?

A
  1. anterolateral = LAD + LCx
  2. posteromedial = RCA (PDA)

oral boards (15 decks)

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