Aortic Valve Disease

Question 1

Level of evidence A

Answer 1

multiple RCTs, multiple populations evaluated

Question 2

Level of Evidence B

Answer 2

single randomized trial or nonrandomized studies

Question 3

Level of evidence C

Answer 3

expert opinion, case studies, or “standard of care”

Question 4

in biscusp AV, which leaflets are most commonly fused?

Answer 4

R + L

Question 5

what is the most common valvular lesion in USA?

Answer 5

AS

Question 6

what percent of population has bicusp AV?

Answer 6

1-2%

Question 7

what is almost always associated with rheumatic AS?

Answer 7

MV involvement

Question 8

what is the appearance of a bicusp AV on PLAX of echo?

Answer 8

dome shaped

Question 9

do most bicusp AV become stenotic?

Answer 9

no

Question 10

what is the key to diagnosing rheumatic AS?

Answer 10

MV involvement

Question 11

in a young patient with bicusp AV and HTN, what should you watch out for?

Answer 11

coarctation and dissection

Question 12

besides murmur, what doyou auscultate for SEVERE AS?

Answer 12

loss of A2, late ejection

Question 13

Cardiac output/ Sq rt Gradient= ?

Answer 13

AVA

Question 14

Mod AS: Jet velocity, Mean gradient, AVA

Answer 14

Jet velocity, Mean gradient, AVA

3-4m/s, 25-40mmHg, 1-1.5cm2

Question 15

Stage of AS if at risk with sclerosis or bicuspid/congenital

Answer 15

A (At risk)

Question 16

Stage of AS if mild to mod AS +/- diastolic dysfxn, calcification or rheumatic changes
No sxs

Answer 16

B (Progressive AS)

Question 17

Stage of AS if no sxs, severe calcification, severe AS on echo , LVH, diastolic dysfxn

Answer 17

C1 (asymptomatic severe AS)

Question 18

Test for Stage C1 AS

Answer 18

Stress

Question 19

Stage of AS if severe AS, LV<50%, no sxs

Answer 19

C2

Question 20

Stage of AS if severe w/ sxs, LVH, diastolic dysfxn, +/- PH

Answer 20

D1

Question 21

Protocol for f/u echocardiograms in asymptomatic mild, moderate and severe AS

Answer 21

Q5y, 3y, annually

Question 22

In AS, how much is jet velocity expected to increase per year?

Answer 22

0.3 m/s

Question 23

In AS, how much is gradient expected to increase per year?

Answer 23

7mm Hg

Question 24

In AS, how much is AVA expected to decrease per year?

Answer 24

0.1cm2

Question 25

What stage is severe AS with low EF and LFLG?

Answer 25

D2

Question 26

What stage is severe AS with preserved EF and paradoxical LFLG?

Answer 26

D3

Question 27

What to look for on dobutamine stress to rule in true AS LFLG (not pseudo stenosis )?

Answer 27

Inc in gradient with dobutamine

Question 28

Which trial showed no clinical, echo, CT benefit to statin in AS?

Answer 28

Saltire

Question 29

Can you do a dobutamine study onto differentiate pseudo-AS vs real AS on a pt with normal EF?

Answer 29

No

Question 30

Usually which side of a valve with regurgitation is a vegetation on?

Answer 30

Downstream

Question 31

What stage of AI is severe AR without sxs and normal LVEF?

Answer 31

C1

Question 32

What stage of AI is severe AR, no sxs, LVEF<50% or 50mm?

Answer 32

C2

Question 33

What stage of AI is severe AR, with sxs, LV dilation, +/- LV dysfxn?

Answer 33

D

Question 34

Finding in proximal Ao for severe AI?

Answer 34

Flow reversal

Question 35

Vena contracta defining severe AR

Answer 35

> .6 cm

Question 36

ERO defining severe AR

Answer 36

> . cm2

Question 37

Medical Treatment for acute AI

Answer 37

Nipride (ideal)
Hydralazine
No IABP

Question 38

How often do you get echo in patients with severe AI or root root dilatation?

Answer 38

Yearly

Question 39

What is main factor that decides operative mortality for AI?

Answer 39

LV fxn

Question 40

AI indications for Sx

Answer 40

Sxs (I)
LVEF < 50%
LV Dil: ESD> 50mm or EDD> 65mm

Question 41

Hakai eqn in cath lab

Answer 41

AVA= CO/ sq rt P2P