Diseases of the Aorta Flashcards
The cardiovascular abnormalities seen with Marfan syndrome include all of the following EXCEPT:
A. Dilatation of the aortic root, sinuses of Valsalva, ascending aorta
B. Aortic dissection
C. Mitral valve prolapse
D. Mitral supravalvular ring
D. Marfan syndrome is a generalized disorder of connective tissue that is inherited as an autosomal dominant trait. Cardiac abnormalities occur in at least 60% of affected adults. The primary cardiovascular lesion in adults is dilatation of the aortic ring, sinuses of Valsalva and ascending aorta. Stretching of the aortic valve leads to aortic regurgitation, aortic dissection or both. Mitral valve prolapse and mitral regurgitation are common findings.
A possible etiology for aortic aneurysm is:
A. Aortic regurgitation
B. Coronary artery disease
C. Marfan syndrome
D. Dilated cardiomyopathy
C. Marfan syndrome is associated with dilatation of the aortic annulus, sinus of Valsalva and ascending aorta, aortic dissection, multivalvular prolapse (e.g., mitral valve prolapse, tricuspid valve prolapse) and valvular regurgitation (aortic regurgitation, mitral regurgitation).
Arteriosclerosis is probably the most common cause of aortic aneurysm. Syphilis is associated with aortic aneurysm that can arise anywhere along the aorta but the most common location is the ascending aorta.
The most common location for aneurysm of the aorta is the:
A. Ascending aorta
B. Transverse aorta
C. Descending thoracic aorta
D. Abdominal aorta
D. 75% of all aortic aneurysm are located in the abdominal aorta below the renal arteries (infra-renal). An anterior-posterior diameter of > 3.0 cm is the definition of abdominal aorta aneurysm (AAA). 50% of patients with abdominal aortic aneurysms have iliac artery aneurysm and 50% of patients with popliteal artery aneurysm will have abdominal aortic aneurysm.
It has been proposed that a screening of the abdominal aorta be included in a standard echocardiographic examination.
Echocardiographic criteria for the diagnosis of aortic dissection include all of the following EXCEPT:
A. Decrease in aortic dimension
B. Recognition of an intimal flap within the aorta
C. Pleural effusion
D. Pericardial effusion
A. Aortic dissection results from an intimal tear of the aortic wall. Two-dimensional findings include dilated aorta, visualization of the intimal flap (preferably in two views), a true lumen and false lumen (best seen in short-axis views), pericardial effusion and pleural effusion.
Aortic regurgitation is a Doppler common finding when the ascending aorta is involved.
Pericardial effusion and/or pleural effusion may be important indicators of impending rupture of the aorta.
An intimal flap in the aorta is discovered in the parasternal long-axis view, suprasternal long-axis view of the aorta and subcostal long-axis of the abdominal aorta. The type of aortic dissection is DeBakey type:
A. I
В. II
С. III
D. B
A. The DeBakey classification for aortic dissection is as follows:
• Type I Dissection of both the ascending aorta and descending thoracic aorta
• Type II Dissection confined to the ascending aorta
• Type IlI Dissection of the descending thoracic aorta
The Stanford classification for aortic dissection is:
• Type A all dissections which involve the ascending aorta (DeBakey’s type I and II)
• Type B all dissections that do not include the ascending aorta (DeBakey type III)
A two-dimensional echocardiographic finding for an aortic intimal flap indicates aortic:
A. Aneurysm
B. Dissection
C. Regurgitation
D. Stenosis
B. Identification of an intimal flap as an oscillating linear echo within the aortic lumen preferably visualized in two views is the classic finding for aortic dissection coupled with a dilated aorta.
Possible complications of aortic dissection include all of the following EXCEPT:
A. Aortic regurgitation
B. Left ventricular inflow tract obstruction
C. Pericardial effusion
D. Progressive enlargement of the aorta
B. In addition occlusion of major systemic arteries is associated with aortic dissection. Unilateral reduction in blood pressure in the right arm versus the left arm as well as a variety of other findings suggest compromise of distal vessels.
A patient with a long-standing history of systemic hypertension is sent to the emergency room after developing chest pain that radiated to the back. The electrocardiogram demonstrated left ventricular hypertrophy and the chest roentgenogram revealed a widening of the superior mediastinum. A possible diagnosis is:
A. Acute severe mitral regurgitation
B. Aortic dissection
C. Mitral stenosis
D. Pericarditis
B. This case is a classic presentation of aortic dissection. Hypertension is a possible etiology of aortic dissection. Chest pain radiating to the back is a classic sign of aortic dissection as well as the widening of the superior mediastinum on chest roentgenogram.
The __________ sinus of Valsalva is the most common sinus involved in sinus of Valsalva aneurysm.
A. Right
B. Left
C. Non-coronary
D. All three are equally involved in sinus of Valsalva aneurysm
A. The right sinus of Valsalva is most often affected (69%) followed by the noncoronary (26%) with the left sinus of Valsalva involved in 5% of cases.
Sinus of Valsalva aneurysm may be ruptured or unruptured.
Associated anomalies of sinus of Valsalva aneurysm include all of the following EXCEPT:
A. Atrial septal defect
B. Bicuspid aortic valve
C. Coarctation of the aorta
D. Ventricular septal defect
A. Sinus of Valsalva aneurysm may be congenital or acquired. The parasternal long-axis view and parasternal short-axis view of the aortic valve allows visualization of the aortic sinuses and aneurysmal formation usually into the right ventricle. Rupture is possible and rupture of the right sinus into the right ventricle is the most common complication of sinus of Valsalva aneurysm.
Color flow Doppler will demonstrate turbulent (mosaic) continuous flow into the receiving chamber (e.g., right sinus into the right ventricle; non-coronary sinus into the right atrium).
Types of supravalvular aortic stenosis include all of the following EXCEPT:
A. Hourglass
B. Tunnel
C. Hypertrophic
D. Dissected
D. There are three basic types of supravalvular aortic stenosis: hourglass (most common in adults), membranous and hypoplasia of the aorta (“strand” aorta). The hourglass deformity consists of a localized segment, hourglass in shape, that narrows immediately above the aortic sinuses.
Hypoplasia (strand) is most common in newborns with hypoplastic left heart syndrome.
All of the following are true concerning supravalvular aortic stenosis EXCEPT:
A. Left ventricular volume overload
B. Hourglass type associated with Williams syndrome
C. Parasternal long-axis view allows visualization
D. Associated with proximal coronary artery dilatation
A. Supravalvular aortic stenosis is considered a left ventricular pressure overload (similar to valvular aortic stenosis, coarctation of the aorta) and will initially result in concentric left ventricular hypertrophy.
The apical five-chamber or apical long-axis view should be interrogated with continuous-wave Doppler to determine the peak velocity, peak pressure gradient and mean pressure gradient across the obstruction.
A membrane stretching from the left side of the interventricular septum to the right side of the anterior leaflet of the mitral valve is called:
A. Discrete subaortic stenosis
B. Hourglass aortic stenosis
C. “Strand” aorta
D. Aortic dissection
A. Discrete subaortic stenosis (DSS) is a thin fibrous membrane located just beneath the aortic valve in the left ventricular outflow tract.
Echocardiographic findings include a thin membrane best seen in the apical long-axis, apical five-chamber and apical long-axis views. Early systolic closure of the aortic may be seen on M-mode of the aortic valve. Aortic regurgitation is a common finding. Continuous-wave Doppler should be used to determine the peak velocity, peak pressure gradient and mean pressure gradient across the membrane.
