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Week 4 & 5: Mitral Regurgitation > Echo Assessment > Flashcards

Echo Assessment Flashcards

1
Q

What is the “seagull” sign in ischaemic MR?

A
  • Asymmetric tethering of amvl due to secondary chords
  • Creates kink in amvl => poor coaptation
  • Concave appearance of amvl
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2
Q

Hypertrophic CM: Aetiology of MR and Mechanism of MR

A
  • Aetiology: dynamic – hypertrophic obstructive cardiomyopathy
  • Mechanism: abnormal – systolic anterior motion of amvl (Type IV)
  • Note: the mechanism is important – MV repair is NOT indicated as the valve is not causing the MR
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3
Q

What is the definition of mitral valve prolapse (MVP)?

A
  • Primary cause of MR; Carpentier Type II (excessive leaflet motion)
  • Abnormal systolic displacement of one or both leaflets into LA due to a disruption or elongation of leaflets, chordae or papillary muscles
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4
Q

Label the MV scallops seen in PSAX?

A
  • Top leaflet = A (anterior)
  • Bottom leaflet = P (posterior)
  • Left to right = lateral, middle, medial
  • A3, A2, A1
  • P3, P2, P1
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5
Q

Which MV scallops are seen in PLAX?

A

A2 and P2

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6
Q

Which MV scallops are seen in PSAX?

A

All scallops seen

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7
Q

Which MV scallops are seen in AP4?

A

A3, A2 and P1

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8
Q

Which MV scallops are seen in AP2?

A

P3, A2 and P1

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9
Q

What is the echo criteria for MVP?

A
  1. Billowing of MV leaflets ≥ 2mm above annular plane in long-axis views
  2. “Hammocking” of the MV

(PLAX or AP3; diagnosis should be made on long axis views unless severe)

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10
Q

What are the common causes of MVP?

A
  1. Barlow’s disease
  2. Fibroelastic deficiency (FED)
  3. Mitral annular disjunction (MAD)
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11
Q

Barlow’s MVP: Leaflets

A
  • Bulky and billowing
  • Cul-de-sac at base of posterior leaflet
  • Floppy redundant valve, excessive leaflet tissue
  • Fused and matted chords
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12
Q

Barlow’s MVP: Prolapse segments

A
  • Multi-segment prolapse

- Bileaflet MVP common

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13
Q

Barlow’s MVP: Non-prolapse segments

A
  • Billowing of body of both leaflets including non-prolapsing segments
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14
Q

Barlow’s MVP: Annulus

A
  • Always dilated

- Calcification common

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15
Q

Barlow’s MVP: Chordal rupture

A

Uncommon

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16
Q

Barlow’s MVP: Patient age

A

Younger (<60 yrs)

17
Q

FED: Leaflets

A
  • Thin, prolapsing segment may appear bulky
  • Thin, almost transparent leaflets
  • Chordal thinning, elongation and rupture
18
Q

FED: Prolapse segments

A

Single segment prolapse (P2 most common)

19
Q

FED: Non-prolapse segments

A

No billowing of non-prolapsing segments

20
Q

FED: Annulus

A

Variably dilated (less than Barlow’s)

21
Q

FED: Chordal rupture

A

Common

22
Q

FED: Patient age

A

Older (> 60yrs)

23
Q

Barlow’s MVP: Aetiology and Mechanism of MR

A

Aetiology: primary degenerative MV
Mechanism: abnormal leaflet motion - excessive motion/prolapse (Type II)

24
Q

FED: Aetiology and Mechanism of MR

A

Aetiology: primary degenerative MV
Mechanism: abnormal leaflet motion - excessive motion/prolapse (Type II)

25
Q

MR Jet Direction in Anterior MVP?

A
  • Posterior MR jet
26
Q

MR Jet Direction in Posterior MVP?

A
  • Anterior MR jet
27
Q

MR Jet Direction in Bileaflet MVP?

A
  • Central MR jet
28
Q

What is mitral annular disjunction (MAD)?

A

Atrial displacement of hingepoint of MV from ventricular myocardium

29
Q

MAD: Leaflets

A
  • Hypermobility of MV apparatus with systolic curling
  • Separation between LA-MV junction and LV attachment
  • Paradoxical systolic ↑ in annulus diameter (systolic diameter > diastolic diameter)
30
Q

MAD: DTI Lateral Annulus

A

“Pickelhaube” (spike) sign (s’ > 16cm/s)

31
Q

MAD: Patient Age/Symptoms

A
  • 30-40yrs

- Present with palpitations

32
Q

MAD: Importance

A
  • Linked with ventricular arrhythmias and sudden cardiac death
33
Q

What is the “Pickelhaube” Sign?

A
  • Seen in MAD
  • Tugging of PM pap. muscle in mid-systole by prolapsing leaflets
  • Causes adjacent LV wall to be pulled sharply toward LV apex (s’ spike)
  • Optimal location of highest velocity is from APLAX/AP3 at posterolateral annulus
34
Q

LA Size in Severe (usually primary) Chronic MR

A
  • LA dilatation due to chronic LA volume overload
  • Normal LA size virtually excludes severe chronic MR
  • LA dilatation occurs in other disease states therefore LA dilatation does not imply severe MR
35
Q

LV Size in Primary MR

A

LV dilatation occurs due to chronic LV volume overload

36
Q

LV Size in Secondary/Functional MR

A
  • MR due to LV dysfunction
  • MR further contributes to ↑ LV size
  • Progressive LV systolic dysfunction and adverse remodelling => ↑ MR severity
  • Degree of LV dilatation not reflective of MR severity
37
Q

Pathophysiology of PHTN in MR

A
  • Post-capillary PHTN
  • Chronic severe MR => compensatory (LV and) LA dilatation => (LV systolic and diastolic dysfunction) => reduced LA compliance and ↑ LAP
  • Backward transmission of ↑ LAP can cause secondary PHTN
38
Q

Surgical Indications for Severe Primary MR

A

Surgery should be considered in:
- Asymptomatic patients with preserved LV function (LVESD <40mm and LVEF >60%) and AF secondary to MR or PHTN (systolic pulmonary pressure at rest > 50mmHg)

Week 4 & 5: Mitral Regurgitation (3 decks)

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