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Annette Vegas TEE Notes > Ch 11 Mitral Valve, Regurgitation and Stenosis > Flashcards

Ch 11 Mitral Valve, Regurgitation and Stenosis Flashcards

1
Q

The right* trigone of the mitral valve is near what aortic valve coronary *cusp?

A

Right trigone = Near non-coronary cusp

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2
Q

The left* trigone of the mitral valve is near what aortic valve coronary *cusp?

A

Left trigone = Near Left Coronary Cusp

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3
Q

What is the shape of the Aortic Valve and Pulmonary Valve?

A

Crown shaped

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4
Q

What is the shape of the mitral Valve and tricuspid Valve?

A

Incomplete ovals

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5
Q

Why is the P2 scallop more prone to chordal rupture and pathological lesions?

A

Mitral annuli fibrosa = Incomplete and becomes thinner is the posterior region

  1. More prone to dilatation
  2. High tension on the area = More prone to chordal rupture
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6
Q

What is the highest points of the mitral valve?

A

ME view LAX (120 degrees)

Measure SAX MV annulus end-diastole (<36mm) = Highest point

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7
Q

What is the lowest points of the mitral valve?

A

Commissural View

Measure LAX MV annulus end-diastole (<46mm)

Nadirs are at the commisures

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8
Q

What shape is the mitral valve annulus during:

Systole?
vs.

Diastole?

A

Systole = Circular shape

Diastole = An ellipse is a circle that has been stretched in one direction, to give it the shape of an oval

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9
Q

How much does the orifice area change from systole to diastole due to the constantly changing shape of the mitral valve?

A

Up to 40%

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10
Q

Normally, what is the leaftlet height ratio of the mitral valve (Anterior compared to posterior)?

A

AMVL (2x) > PMVL (1x)

Also, SAM is more likely when the A/P ratio is <1.3

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11
Q

Normally, what is the leaftlet circumference ratio of the mitral valve (Anterior compared to posterior)?

A

PMVL (70%) > AMVL (30%)

Said another way, the circumference of the mitral valve is only 30% of the AMVL vs. 70% of the posterior leaflet

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12
Q

Normally, what is the leaftlet height area of the mitral valve (Anterior compared to posterior)?

A

Area = For both anterior vs. posterior leaflets

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13
Q

Normally, what is the leaftlet coaptation area of the mitral valve (Anterior compared to posterior)?

A

30% (1 cm length)

What this means = Combined surface area of the mitral valve leaftlets is 2x the mitral orifice.

This permits a large area of coaptation (30%, 1 cm length), thus minimizing chordal tension.

Reducing this contact area as occursr in mitral annular dilation increasing chordal tension and thus rupture

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14
Q

What is the carpentier classification of mitral valve anatomy?

A

A1, A2, A3

P1, P2, P3

Anterior commissure near lateral aspect (A1 and P1)

Posterior commissure near medial aspect (A3 and P3)

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15
Q

Mitral Valve Chordae:

What is first order?

What is second order?

What is third order?

A

1st = Marginal; = Leaflet free margin, prevents prolapse

2nd = leaflet LV aspect, relieves excessive tension

3rd = LV wall insert (only base of PMVL)

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16
Q

What is the blood supply of the anterolateral papillary muscle?

A
  1. LCX (OM1 branch)
  2. LAD (Diagonal arteries)
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17
Q

What is the blood supply of the posteriomedial papillary muscle?

A

RCA

or

OM3 (LCX) if left dominant

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18
Q

When are mitral valve leaflets determined to be thickened?

A

>5 mm

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19
Q

When is the mitral valve annulus to be measured?

What is normal short axis of the mitral valve measurement?

A

Mid-Diastole (Start of the P-wave)

Normal measurement = 30-35 mm (SAX of MV seen in the ME LAX)

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20
Q

What leaflets are seen in the MV commissural view?

A

Left of screen = P3

Middle = A2

Right of screen = P1

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21
Q

What MV leaflets are seen in the 2 chamber views?

A

Left = P2

Right = A2/A1

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22
Q

What is normal doppler velocities of the mitral valve?

A

< 1 m/s (<100 cm/sec)

23
Q

What is a normal Emax velocities during dopplers of the MV inflow?

A

60 - 80 cm/sec

24
Q

What is a normal Amax velocities during dopplers of the MV inflow?

A

20 - 40 cm/sec

25
Q

What is a normal MV area?

A

4-6 cm2

26
Q

What are normal MV annulus measurements?

(Short axis vs. Long axis)

A

SAX = 30 - 35 mm (>36 mm = Dilated)

LAX = 40-45 (>46 mm = Dilated)

27
Q

What is normal anterior leaflet mitral valve length?

A

1.9 cm

28
Q

What is normal posterior leaflet mitral valve length?

A

1.0 cm

29
Q

What is functional MR?

A

Structurally normal MV leaflets causing central or eccentric MR

30
Q

What is diastolic MR?

A

LV pressure > LAP during diastole

  • Pressure gradient often is the regurgitant volume
31
Q

What happens during MVP (Mitral valve prolapse)?

A

Systolic displacement of one or more MV segments beyond the annular plane of the MV.

32
Q

What is the best view to correctly diagnose MVP?

A

ME LAX

  • only diagnosed when mitral leaflets move beyond the annular high points
  • Both leaflets, LA, LVOT, and AV are seen
33
Q

What is Type I Carpentier Classification for MR?

A

Normal Leaflet motion

34
Q

What is Type II Carpentier Classification for MR?

A

Excessive Leaflet Motion

35
Q

What is Type IIIa Carpentier Classification for MR?

A

Restricted Leaflet Motion (Systole and Diastole)

36
Q

What is Type IIIb Carpentier Classification for MR?

A

Restricted Motion (Systole only)

37
Q

When could you see an anterior MV regurgitant jet?

A
  1. Posterior Prolapse
  2. Anterior Restriction
38
Q

When could you see a posterior MV regurgitant jet?

A
  1. Anterior Prolapse
  2. Posterior restriction
  3. SAM
39
Q

Left off on page 102

A

Left off on page 102

40
Q

What is the normal Mitral Valve area?

A

4 - 6 cm2

41
Q

What is the normal peak velocity across the mitral valve?

A

0.6 - 1.0 meters/sec (60 - 100 cm/sec)

42
Q

What MV area would be mild mitral stenosis?

A

1.5 - 2.5 cm

43
Q

What MV area would be moderate mitral stenosis?

A

1.0 - 1.5 cm2

44
Q

What MV area would be Severe mitral stenosis?

A

< 1.0 cm2

45
Q

What is the most common cause of mitral stenosis in adults?

A

Rheumatic heart disease

46
Q

What happens to the leaflets in Mitral Stenosis?

A

Thickens

47
Q

What happens to the commissures in Mitral Stenosis?

A

Fusion

48
Q

What happens to the chordae in mitral stenosis?

A

Chordae shorten

49
Q

What is the 2nd most common cause of Mitral stenosis in adults?

A

MAC (Mitral annular calcification)

50
Q

What are the less common causes of MAC?

A

Congenital

SLE

Rheumatoid Arthritis

Carcinoid Syndrome

51
Q

What is the most important 2d echo feature of MS?

A

Restricted MV leaflet opening

52
Q

What degree of thickness of the leaflets occur in Rheumatoid Mitral stenosis?

A

Leaftlet thickness <3 mm

53
Q

Why does the “hockey stick” appearance occur?

A

Diastolic Doming

Diastole = (AMVL) bows from elevated LAP (Left atrial pressure)

Leaflets tips remains tethered = Hockey stick apperance)

Annette Vegas TEE Notes (20 decks)

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