CARDIAC Section 3: Valves Flashcards
What does this image demonstrate?
What’s the diagnosis?
Regurgitant jet in a Three chamber cardia MR still image
Aortic Regurgitation
What planes do you use to see the Stenotic/regurgitant Flow jets
Orthogonal planes
What is a set parameter of phase-contrast imaging used for quantifying the velocity of flowing blood?
Velocity-encoded cine MR (VENC)
In VENC, what happens if the velocity range is too low?
How should you set it?
You will get the classic ALIASING artifact
Select a velocity 20-25% highger than the expected maximum
Identify the valve
Aortic valve
What is the most SUPERIOR valve of the heart?
Pulmonic valve
What is the most ANTERIOR valve of the heart?
Tricuspid Valve
What’s above and What’s below?
Aortic above
Mitral belowW
What modality is the best first choice to look at the valveS?
ECHO
What MRI slices allow you to quantify the regurgitant volume?
When is it measured?
Transverse slices positioned at the valve - during diastole
What causes AORTIC STENOSIS?
Congenital - BISCUPID
Acquired - Degenerative or Rheumatic Heart
What cardiac condition is linked with increased afterload and concentric LV hypertrophy?
Aortic stenosis.
What imaging technique is used to quantify the velocity of blood flow in aortic stenosis?
Velocity-encoded cine MR imaging (VENC) or phase-contrast imaging.
What causes dilation of the ascending aorta in aortic stenosis?
Jet phenomenon related to a stenotic valve.
Name the three types of aortic stenosis.
Valvular, subvalvular, and supravalvular.
What syndrome is associated with supra-valvular aortic stenosis?
Williams Syndrome.
What condition is indicated by bicuspid aortic valve and coarctation?
Turner’s Syndrome.
What percentage of the general population is affected by bicuspid aortic valve?
Nearly 2%.
What is the most common congenital heart disease?
Bicuspid aortic valve.
What is a significant complication of bicuspid aortic valve?
Aortic stenosis.
What syndrome is associated with bicuspid aortic valve?
Cystic Medial Necrosis
Tuerners Syndrome
Coarctation
AD Polycystic Kidney Disease
What is the most common Variant of Bicuspid Aortic Valve?
Type I Variant
What is an independent risk factor of aortic aneurysm
Bicuspid Aortic Valve
What are some causes of aortic regurgitation?
Bicuspid aortic valves, bacterial endocarditis, Marfan’s syndrome, hypertension-caused aortic root dilation, and aortic dissection.
What determines the hemodynamic impact of aortic regurgitation?
The rapidity of onset.
“Austin Flint Murmur”
What is the most common cause of mitral stenosis?
Rheumatic heart disease.
What are some radiological signs of mitral stenosis on a chest X-ray?
Double density sign, splaying of the carina, posterior esophageal displacement, walking man sign
Basically LA cardiomegaly
Name the three types of pulmonary stenosis.
Valvular, subvalvular, and supravalvular.
What syndrome is associated with valvular pulmonary stenosis?
Noonan’s Syndrome
What syndrome is associated with SUPRA-valvular pulmonary stenosis?
William’s Syndrome
What syndrome is associated with SUBalvular pulmonary stenosis?
TOF
What condition is commonly seen with Alagille syndrome?
Peripheral pulmonary stenosis.
What is the primary complication following TOF repair?
Pulmonary regurgitation.
What is crucial for timing the repair of pulmonary regurgitation?
Cardiac MRI, to assess RV dilation.
What involves patch repari of the VSD and relief of the RV outlet obstruction?
TOF repair involves patch repair of the VSD and relief of the RV outlet obstruction.
What is the most common form of tricuspid disease?
Tricuspid Regurgitation (weak annulus compared to mitral)
What are some causes of tricuspid regurgitation?
Pulmonary arterial hypertension (MOST COMMON)
Endocarditis (especially in IV drug users),
Carcinoid syndrome (serotonin degrades the valve)
What is the effect of tricuspid regurgitation on the right ventricle?
It causes RV dilation, not RV hypertrophy.
What are the common vavles involved in Rheumatic heart disease?
MV
AV
When there is Multivalve disease, think of?
Rheumatic Fever!
What heart disease is an immune modulated response to Group A- Beta hemolytic strep?
Rheumatic Heart Disease
What maternal factor is associated with Ebstein Anomaly in children?
Use of Lithium during pregnancy.
Describe the cardiac abnormalities in Ebstein Anomaly.
Hypoplastic tricuspid valve, apically displaced posterior leaf (downward), enlarged right atrium, decreased right ventricle (“atrialized”), and tricuspid regurgitation.
Diagnosis?
Ebstein Anomaly
What effect does carcinoid syndrome have on heart valves?
It causes valvular disease, typically affecting the tricuspid and pulmonic valves, due to serotonin degrading the valves.
When is left-sided valvular disease seen in carcinoid syndrome, and what are two scenarios to consider?
Left-sided disease is rare and suggests either a primary bronchial carcinoid or right-to-left cardiac shunts.
