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Echo 2 > C10: TV and PV Stenosis > Flashcards

C10: TV and PV Stenosis Flashcards

1
Q

Is congenital TS usually associates with other congenital heart abnormalities

A

Yes

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2
Q

angle b/w the TV and PV

A

45 degrees

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3
Q

3 commissures of the TV

A

anteroseptal
anteroposterior
posteroseptal

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4
Q

possible congenital causes of TS

A

various malformations of the TV complex:

mal-developed leaflets
shortened chordae
annular hypoplasia
abnormalities of the pap muscles
cor triatriatum dexter
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5
Q

most common cause of acquired TS

other causes

A

rheumatic fever

carcinoid heart disease
Tv vegetation
Rt heart tumors or thrombus

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6
Q

describe rheumatic TS

anatomic changes seen w/ rheumatic TS

A

starts at the leaflet tips, infection occurs several years after the initial beta-hemolytic streptococcus infection as an autoimmune response

thickening, fibrosis, fused leaflets and chordae which causes diastolic dooming… you will see the equivalent of the hockey stick w/ the MV

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7
Q

is stenosis of the TV usually severe

why or why not

A

no, because the valve itself is so big

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8
Q

does rheumatic TS usually cause TS and TR

A

yes

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9
Q

describe carcinoid heart disease

how does it cause TS

A

rare, malignant neuroendocrine tumor that secretes serotonin which damages both the TV and the PV due to the formation of plaque… plaque causes the valve and chordae to thicken, retracted and rigid

second most common cause of TS

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10
Q

specimen appearance of carcinoid heart disease on the TV

A

milky-white plaque like deposits on the endocardial surfaces and myocardium

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11
Q

is the Lt heart often affected by hormones release from the carcinoid tumour

A

no, lungs will filter out the serotonin

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12
Q

what is cor triatriatum dexter

A

perforated membrane siting in the RA

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13
Q

describe the pathophysiology of TS

A

TS reduces tha area of the conduit b/w the RA and the RV… RA press must rise in order to maintain cardiac output which increases the driving press across the valve…
….eventually the increase in press works its way backwards towards the systemic veins

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14
Q

symptoms of TS

A

fatigue
abdo discomfort
swelling

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15
Q

how to tell the difference b/w carcinoid HD and rheumatic HD

A

carcinoid will involve the TV AND PV, and never the MV

rheumatic almost always involves the MV, where as PV is the last to be affected by rheumatic

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16
Q

w/ what type of TV disease is the RV spared

A

if theres stenosis only…. not w/ regurg

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17
Q

how do you performing a measurement for the Mean TV press gradient and VTI

A
  • measure from the view which is most parallel to TV inflow jet
  • trace the TV inflow envelope which will give you the mean PG and the VTI
  • measurement should be done w/ a normal HR
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18
Q

how much can the TV inflow vary with respiration to be considered normal

A

up to 25% (is this right?)

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19
Q

which is more important w/ TS, mean PG or max PG

A

mean PG

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20
Q

what does the Tv press half time measure

what does the diastolic slope represent

A

the time it takes for the early diastolic PG to fall to half it’s original value…

the PG b/w the RV and RA during diastole

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21
Q

how dose the size of the TV affect its CW wave profile

A

lower velocity profile w/ rapid deceleration time

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22
Q

what PHT value measured @ end-expiration indicates severe TS

A

> 190 ms

23
Q

ideally, when should you measure the PHT for TS

A

end expiration, or avg over several beats

24
Q

formula to calculate TV area

A

TVA = (pie x r^2)LVOT x VTI of LVOT) / VTI of TV

25
Q

limitation of TVA

A
  • suboptimal alignment to the jet direction
  • improper LVOT diameter or VTI measurement
  • significant TR (cant use continuity equation for TVA)
26
Q

when cant we use TVA to assess TS severity

what do we do instead

A

if there is significant TR which alters the SV…. use PHT or mean gradient instead

27
Q

mean gradient value for significant TS

A

> /= 5 mmHg

28
Q

inflow VTI value for significant TS

A

> 60 cm

29
Q

PHT value for significant TS

A

> 190 ms

30
Q

TVA value for significant TS

A

= 1 cm^2

31
Q

supportive findings for severe TS

A

enlarged RA > or = moderate

dilated IVC

32
Q

treatment for TS

A
  • surgical de-bulking of tumor or vegetation
  • diuretics, or nitrates to relieve venous congestion
  • transvenous balloon valvuloplasty
33
Q

cusps of the TV and PV

A

TV: anterior, posterior, septal

PV: right, left, anterior

34
Q

is the PV supported by the IVS?

where does it get its support

A

no

muscular ridge called the infundibulum, located b/w the RVOT and LVOT

35
Q

relationship of PA to AO

A

anterior

36
Q

RVOT possible levels of obstruction

A

subvalvular/infundibular
valvular
supravalvular
pulmonary artery branches

37
Q

common cause of PS

A

almost always congenital… acquired is uncommon

38
Q

3 types of congenital PS

A

typical domed shaped PV
dysplastic PV
unicuspid or bicuspid PV

39
Q

cause of acquired PS

A 
rheumatic HD
carcinoid HD
hypertrophic cardiomyopathy
tumors, thrombus
vegetation
extraneous TV tissue
PV sinus of valsalva aneurysm
40
Q

why would we measure the PV annulus w/ PS

why is this important

in which view do we measure

A

for possible PV valvuloplasty

crucial to select the correct size balloon

PSAX RVOT

41
Q

what changes in the RV can we look for to support the finding of PS

A

RVH due to high afterload to the RV

42
Q

is RVH symmetrical

A

no, asymmetrical, unlike the LV

43
Q

2 criteria used to assess the severity of PS

A

peak PV velocity

maximum gradient

44
Q

peak PV velocity value for mild PS

severe

A

< 3

> 4

45
Q

peak PV maximum gradient value for mild PS

severe

A

< 36

> 64

(4 times the peak velocity squared will give you this)
e.g. 4 (3^2) = 36 (mild PS)
4 (4^2) = 64 (severe PS)

46
Q

do we calculate the PV area using the continuity equation

A

no, this method is not used for the PV

47
Q

procedure of choice for sever congenital PS

A

PV valvuloplasty

48
Q

when is RVSP equal to PASP

what about if the RVOT is obstructed

A

when theres no obstruction of the RVOT

RVSP will be higher than the PASP

49
Q

w/ mild or moderate RVOT obstruction, what formula do we use to calculate PASP

A

PASP = RVSP - mPG of the PV

mPG = mean pressure gradient (do a CW through the PV and trace it to get this)

50
Q

w/ severe or critical RVOT obstruction, what formula do we use to calculate PASP

A

PASP = RVSP - MIPG of the PV

MIPG = maximum instantaneous PG

51
Q

spectral waveform shape of mild PS

critical

A

mild: V shape w/ early peaking waveform (press equalizes faster)
critical: parabolic w/ mid peaking waveform

59
Q

Why is mean gradient more useful than peak velocity for TS

A

There’s more than 1 peak during the diastolic cycle and the diastolic cycle is longer than the systolic

60
Q

Why do you average several beats when tracing the TV inflow for mean gradient and VTI

A

To account for changes in venous return with respiration

61
Q

Limitation of P1/2 T

A

Tachycardia

Echo 2 (15 decks)

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