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Cardiac Theory II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Transcatheter Mitral clip

A

-replacing the Alferi stitch
-clip placed on leaflets tips to hold together
-blood flows on sides of clip
-brought through the LA to LV

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2
Q

Annuloplasty

A

-D shaped ring placed in left atrium and brings the MV closer together

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3
Q

Surgical Mitral Valve Prolapse Repair

A

-minimally invasive
-triangular resection of sagging scallop
-annular ring is sewn in to tighten annulus
-anterior repair may involve chordal transfer/creation of new chords
-repairs followed by annular ring

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4
Q

Homograft Valve

A

-cryopreserved human aortic or pulmonic valves harvested at autopsy (human to human donation)
-valve conduit: valve with portion of great vessel
-typically preserved as a block

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5
Q

Autograft Valves

A

self to self donation

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6
Q

Artificial Valve Conduits

A

fabric like tube with implanted mechanical valve

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7
Q

Bioprosthetic Tissue Valve

A

heterografts
animal to human donation
3 types: stented (porcine), stentless, catheter

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8
Q

Mechanical Valves

A

made of carbon to titanium
-2 types: Tiilting Disk or Bileaflet

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9
Q

Composition of Bioprosthetic Stented

A

-leaflets or pericardium shaped to mimic leaflets, mounted on cloth covered rigid support ring with a raised stent at each of the 3 commissures

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10
Q

Composition of Bioprosthetic Stentless

A

-flexible cuff of fabric or tissue support the valve leaflets
-coronary arteries may need to be reattached

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11
Q

Composition of Catheter

A

-transcatheter aortic valve replacement “TAVR”
-tissue leaflets mounted on compressible stent

Specially designed bioprosthetic vavles implanted by transcatheter approach with tissue leaflets mounted on compressible stent

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12
Q

Mechanical Bileaflet

A

-two semicircular disks hinged on sewing ring
-two thin lines of reverberation
-2 large lateral inflow
-1 small central inflow

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13
Q

Mechanical Tilting disk

A

-singular circular disk supported on central strut running across the sewing ring
-major and minor inflow
-one thick line of reverberation

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14
Q

Ross Procedure

A

-self to self donation
-AV is replaced with child’s own PV = pulmonary autograft
-homograft put in PV position

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15
Q

Advantage and disadvantage of Bioprosthetic

A

Advantage: does not require anticoagulation therapy
Disadvantage: average longevity is 10 years due to degenerative calcific process

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16
Q

Advantage and disadvantage of Mechanical

A

Advantage: longevity due to durability
Disadvantage: lifelong anticoagulation therapy

17
Q

Bioprosthetic Valve Stenosis

A

-fibrocalcific changes of leaflets
-results in resistance to opening

18
Q

Bioprosthetic Valve Regurgitation

A

-fibrocalcific changes of leaflets
-results in failure to coapt
-acute regurgitation: if calcium tears leaflets
-paravalvular regurgitation: loss of suture material postoperatively

19
Q

Mechanical Valve Stenosis

A

-due to thrombus formation or pannus ingrowth around valve
-failure due to faulty design or wear & tear resulting in incomplete valve closure or disk escape

20
Q

Mechanical Valve Regurgitation

A

-due to thrombus formation or pannus ingrowth around valve
-failure due to faulty design or wear & tear resulting in incomplete valve closure or disk escape
-paravalvular regurgitation: loss of suture material postoperatively

21
Q

Paravalvular Regurgitation

A

-loss of suture material postoperatively
-regurgitation between tissue and sewing ring

22
Q

Dehiscense

A

-major loss of sutures thus sewing ring is no longer adequately seated and the prosthesis rises off the annulus
-“rocking” motion of prosthetic

23
Q

Endocarditis on bioprosthetic

A

-presents as vegetations

24
Q

Endocarditis on mechanical

A

-presents as paravalvular abscess
-pocket of infection separating the valve from the sewing ring

25
Q

2D appearance on Bioprosthetic Stented

A

-hard to visualize 3 leaflets
-metal struts appear as crown

26
Q

2D appearance on Bioprosthetic Stentless

A

-similar to native AV
-increased echogenicity

27
Q

2D appearance on Transcatheter

A

-increased echogenicity of para-annular region

28
Q

2D appearance on Mechanical

A

-severe reverberations and acoustic shadowing
-spontaneous contrast due to microcavitation

29
Q

Doppler tracing through Prosthetic and Mechanical

A

-greater intensity opening and closing clicks
-can cause color flash artifact
-due to occluder, disk, or tissue leaflets hitting sewing ring
-triangular shaped envelopes in mechanical valves

30
Q

Color flow regurgitation pattern on prosthetic

A

Bioprosthetic: central regurgitation
TAVR: mild paravalvular

31
Q

Color flow regurgitation pattern on mechanical

A

Mechanical: crisscross jets, small regurgitant jet circumferentially, closure line regurgitation on tilting disk

32
Q

Baseline Echo

A

-secure within 3 months of valve replacement
-evaluation of regression of LV hypertrophy or dilation
-evaluation of recovery of systolic function
-evaluation of changes in pulmonary pressures

33
Q

AV Quantification

A

Velocity: < 3
MPG: < 20
DVI: ≥ .30
EOA: > 1.2
Accel Time: < 80 (triangular shaped)

34
Q

Severe AV Quantification

A

Velocity: > 4
MPG: > 35
DVI: < .25
EOA: < .8
Accel Time: > 100 (rounded shape)

35
Q

MV Quantification

A

Velocity: < 1.9
MPG: < 5
VTI: < 2.2
EOA: > 2
PHT: < 130

36
Q

Severe MV Quantification

A

Velocity: > 2.5
MPG: > 10
VTI: > 2.5
EOA: < 1
PHT: > 200

37
Q

Comparision Resources

A

Compare values to:
-Baseline Echo (most valuable)
-ASE Guidelines
-Manufacturer

38
Q

Mismatch Prosthetic

A

-done during baseline echo
AV indexed EOA: ≤ .85 cm^2/m^2
Severe AV: ≤ .65 cm^2/m^2
MV indexed EOA: ≤ 1.3 cm^2/m^2

Cardiac Theory II (9 decks)

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