Echocardiography

Question 1

In chronic mitral stenosis, what changes may affect the doppler profile?

Answer 1

• Atrial fibrillation
• left atrial dilation
• left atrial fibrosis

Question 2

Why may there be A wave bluntening on mitral inflows with chronic mitral stenosis

Answer 2

Because left atrial fibrosis from chronic dilation will reduce the contractile ability of the left atrium bluntening the active profile. Additionally, the presence of A-fib from chronic dilation can result in the obliteration of the A-wave

Question 3

Colour signals which may appear in the atrium and are not due to mitral regurgitation can be;

Answer 3

• Turbulent flow from mitral closure
• Reverberation from aortic flow
• Pulmonary vein inflow
• Normal atrial blood flow due to an inappropriate gain and Nyquist limit

Question 4

Not all colour flow in the atrium maybe due to regurgitation. What characteristics must the flow have to be consistent with regurgitation

Answer 4

True charachteristics of mitral regurgitation include;
- Evidence of proximal flow acceleration (PISA)
- The flow conforms to the appearance of a true jet
- Downstream (left atrial) flow is apparently consistent with a volume of blood being ejected through a relatively constraining orifice (vena contracta)
- The flow signal is appropriately confined to systole
- The color doppler signal are appropriate for the anticipated direction and/or reveal the appropriate variance or turbulence

Question 5

Should you interrogate mitral regurgitation with CW or PW and why?

Answer 5

The pressure difference between the LV and LA should be great enough that all regurgitation will exceed the nyquist limit of PW and therefore pulse wave will need to be used.

Question 6

what is the mitral tenting area ?

Answer 6

The mitral Tenting area is a parameter which that can describe the severity of the functional MR. The tenting area is qualified as the area subtended by the plane of the mitral annulus and the belly of the mitral leaflets in systole. With normal coaptation tenting area is minimal. With progressive degrees of apical displacement of the mitral leaflets tenting area increases and is directly related to the severity of the subsequent regurgitation,

Question 7

In humans, what neoplasias can occur on the mitral valve ?

Answer 7

• Occasionally myxoma
  o Often originating from another structure and appears to be associated with the leaflet
• Papilloma
  o Smooth, mobile, spherical with a diameter of 2-10mm
• Fibroelastoma
  o Smooth, mobile, spherical with a diameter of 2-10mm
• Blood cyst
  o Rare – more commonly seen in pediatrics
  o 2mm->1cm
  o Smooth, usually spherical or ovoid cystic structures

Question 8

What are libman-sachs lesions?

Answer 8

These are endocarditis like lesions of the mitral valve which occur due to non infectious causes such as systemic lupus

Question 9

What is annular dehiscence ?

Answer 9

• Infrequent sequala of blunt chest trauma
• Results in substantial mitral regurgitation
  The mitral valve annulus dehiscences from the surrounding tissue

Question 10

What are key charachteristics of radiation damage findings on the mitral valve?

Answer 10

• Very uncommon to encounter radiation damage to the mitral valve
• These are sequala which often occurs 10-15 years post-radiation therapy
• Most radiation portals are anterior thus it is more common for the anterior leaflet to suffer damage
• Nature can be highly variable, and the most common finding is fibrosis and stiffening of the valve