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oral boards > AHA: TR > Flashcards

AHA: TR Flashcards

1
Q

regurgitant jet width (% of RA) in mild TR

A

not specified in either AHA or ASE

%

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2
Q

vena contracta in mild TR

A

<0.3

cm; only specified in ASE

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3
Q

RVol/Vregurg in mild TR

regurgitant volume

A

<30

mL/beat; only specified in ASE

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4
Q

RF in mild TR

regurgitant fraction

A

NO RF for TR specified in either AHA or ASE

%

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5
Q

EROA in mild TR

effective regurgitant orifice area

A

<0.2

cm2; only specified in ASE

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6
Q

grade in mild TR

A

NO grade for TR specified in either AHA or ASE

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7
Q

hep vein flow reversal in mild TR

A

systolic dominance

only specified in ASE

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8
Q

regurgitant jet width (% of RA) in moderate TR

A

not specified in either AHA or ASE

%

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9
Q

vena contracta in moderate TR

A

0.3-0.7

cm; only specified in ASE

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10
Q

RVol/Vregurg in moderate TR

regurgitant volume

A

30-45

mL/beat; only specified in ASE

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11
Q

RF in moderate TR

regurgitant fraction

A

NO RF for TR specified in either AHA or ASE

%

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12
Q

EROA in moderate TR

effective regurgitant orifice area

A

0.2-0.4

cm2; only specified in ASE

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13
Q

grade in moderate TR

A

NO grade for TR specified in either AHA or ASE

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14
Q

hep vein flow reversal in moderate TR

A

systolic blunting

only specified in ASE

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15
Q

regurgitant jet width (% of RA) in severe TR

A

≥50

%

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16
Q

vena contracta in severe TR

A

≥0.7

cm

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17
Q

RVol/Vregurg in severe TR

regurgitant volume

A

≥45

mL/beat

18
Q

RF in severe TR

regurgitant fraction

A

NO RF for TR specified in either AHA or ASE

%

19
Q

EROA in severe TR

effective regurgitant orifice area

A

≥0.4

cm2

20
Q

grade in severe TR

A

NO grade for TR specified in either AHA or ASE

21
Q

hep vein flow reversal in severe TR

22
Q

tricuspid valve

vena contracta <0.3 cm

23
Q

tricuspid valve

RVol/Vregurg <30 mL/beat

regurgitant volume

24
Q

tricuspid valve

EROA <0.2 cm2

effective regurgitant orifice area

25
Q

tricuspid valve

vena contracta = 0.3-0.7 cm

A

moderate TR

26
Q

tricuspid valve

RVol/Vregurg = 30-45 mL/beat

regurgitant volume

A

moderate TR

27
Q

tricuspid valve

EROA = 0.2-0.4 cm2

effective regurgitant orifice area

A

moderate TR

28
Q

tricuspid valve

regurgitant jet width (% of RA) ≥50 %

29
Q

tricuspid valve

vena contracta ≥0.7 cm

30
Q

tricuspid valve

RVol/Vregurg ≥45 mL/beat

regurgitant volume

31
Q

tricuspid valve

EROA ≥0.4 cm2

effective regurgitant orifice area

32
Q

Is degenerative or rheumatic TR more common?

A

neither
~50/50

33
Q

indication(s) for intervention in moderate TR

A
  • progressive + concomitant <3 L valve surg + annulus EDD>40mm regardless of sx status OR prior RH fail sxs (2a)

” In patients with progressive TR (Stage B) undergoing left-sided valve surgery, tricuspid valve surgery can be beneficial in the context of either 1) tricuspid annular dilation (tricuspid annulus end diastolic diameter >4.0 cm) or 2) prior signs and symptoms of right-sided HF.”

34
Q

indication(s) for intervention in moderate TR

(1)

A
  • progressive + concomitant <3 L valve surg + annulus EDD>40mm regardless of sx status OR prior RH fail sxs (2a)

” In patients with progressive TR (Stage B) undergoing left-sided valve surgery, tricuspid valve surgery can be beneficial in the context of either 1) tricuspid annular dilation (tricuspid annulus end diastolic diameter >4.0 cm) or 2) prior signs and symptoms of right-sided HF.”

35
Q

indication(s) for intervention in asx severe TR

A
  • concomitant <3 L valve surg (1)
    regardless of sx status
  • progressive + concomitant <3 L valve surg + annulus EDD>40mm regardless of sx status OR prior RH fail sxs (2a)
  • progressive RV dil or systolic dysfxn (2b)

  • “In patients with severe TR (Stages C and D) undergoing left-sided valve surgery, tricuspid valve surgery is recommended.”
  • “In patients with signs and symptoms of right-sided HF and severe primary TR (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In patients with signs and symptoms of right-sided HF and severe isolated secondary TR attributable to annular dilation (in the absence of pulmonary hypertension or left-sided disease) who are poorly responsive to medical therapy (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In asymptomatic patients with severe primary TR (Stage C) and progressive RV dilation or systolic dysfunction, isolated tricuspid valve surgery may be considered.” (2b)
  • “In patients with signs and symptoms of right-sided HF and severe TR (Stage D) who have undergone previous left-sided valve surgery, reoperation with isolated tricuspid valve surgery may be considered in the absence of severe pulmonary hypertension or severe RV systolic dysfunction.” (2b)
36
Q

indication(s) for intervention in asx severe TR

(3)

A
  • concomitant <3 L valve surg (1)
    regardless of sx status
  • progressive + concomitant <3 L valve surg + annulus EDD>40mm regardless of sx status OR prior RH fail sxs (2a)
  • progressive RV dil or systolic dysfxn (2b)

  • “In patients with severe TR (Stages C and D) undergoing left-sided valve surgery, tricuspid valve surgery is recommended.”
  • “In patients with signs and symptoms of right-sided HF and severe primary TR (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In patients with signs and symptoms of right-sided HF and severe isolated secondary TR attributable to annular dilation (in the absence of pulmonary hypertension or left-sided disease) who are poorly responsive to medical therapy (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In asymptomatic patients with severe primary TR (Stage C) and progressive RV dilation or systolic dysfunction, isolated tricuspid valve surgery may be considered.” (2b)
  • “In patients with signs and symptoms of right-sided HF and severe TR (Stage D) who have undergone previous left-sided valve surgery, reoperation with isolated tricuspid valve surgery may be considered in the absence of severe pulmonary hypertension or severe RV systolic dysfunction.” (2b)
37
Q

indication(s) for intervention in sx severe TR

A
  • concomitant <3 L valve surg (1)
    regardless of sx status
  • progressive + concomitant <3 L valve surg + annulus EDD>40mm regardless of sx status OR prior RH fail sxs (2a)
  • RH fail + 1° TR (2a)
  • RH fail + 2° TR 2/2 annular dil (+ ⊖pHTN/LH fail) + poor response to GDMT (2a)
  • RH fail + h/o prior L valve surg (+ ⊖pHTN, ⊖severe RV systolic dysfxn) (2b)

  • “In patients with severe TR (Stages C and D) undergoing left-sided valve surgery, tricuspid valve surgery is recommended.”
  • “In patients with signs and symptoms of right-sided HF and severe primary TR (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In patients with signs and symptoms of right-sided HF and severe isolated secondary TR attributable to annular dilation (in the absence of pulmonary hypertension or left-sided disease) who are poorly responsive to medical therapy (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In asymptomatic patients with severe primary TR (Stage C) and progressive RV dilation or systolic dysfunction, isolated tricuspid valve surgery may be considered.” (2b)
  • “In patients with signs and symptoms of right-sided HF and severe TR (Stage D) who have undergone previous left-sided valve surgery, reoperation with isolated tricuspid valve surgery may be considered in the absence of severe pulmonary hypertension or severe RV systolic dysfunction.” (2b)
38
Q

indication(s) for intervention in sx severe TR

(5)

A
  • concomitant <3 L valve surg (1)
    regardless of sx status
  • progressive + concomitant <3 L valve surg + annulus EDD>40mm regardless of sx status OR prior RH fail sxs (2a)
  • RH fail + 1° TR (2a)
  • RH fail + 2° TR 2/2 annular dil (+ ⊖pHTN/LH fail) + poor response to GDMT (2a)
  • RH fail + h/o prior L valve surg (+ ⊖pHTN, ⊖severe RV systolic dysfxn) (2b)

  • “In patients with severe TR (Stages C and D) undergoing left-sided valve surgery, tricuspid valve surgery is recommended.”
  • “In patients with signs and symptoms of right-sided HF and severe primary TR (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In patients with signs and symptoms of right-sided HF and severe isolated secondary TR attributable to annular dilation (in the absence of pulmonary hypertension or left-sided disease) who are poorly responsive to medical therapy (Stage D), isolated tricuspid valve surgery can be beneficial to reduce symptoms and recurrent hospitalizations.” (2a)
  • “In asymptomatic patients with severe primary TR (Stage C) and progressive RV dilation or systolic dysfunction, isolated tricuspid valve surgery may be considered.” (2b)
  • “In patients with signs and symptoms of right-sided HF and severe TR (Stage D) who have undergone previous left-sided valve surgery, reoperation with isolated tricuspid valve surgery may be considered in the absence of severe pulmonary hypertension or severe RV systolic dysfunction.” (2b)
39
Q

triangle of Koch boundaries

A

(contains AVN)
- coronary sinus
- tendon of Todaro/Eustachian ridge
- TV annulus (septal leaflet)

40
Q

triangle of Koch contents

41
Q

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

A
  1. AVN @ base of septal leaflet (triangle of Koch)
  2. RCA @ anterior leaflet > posterior leaflet (if L-dominant)
  3. coronary sinus @ posterior leaflet
  • ± aortic valve NCC @ anteroseptal commissure
  • ± bundle of His @ septal leaflet / anteroseptal commissure

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