High yield PTEexam review part 33-35

Question 1

Peak E velocity 46 cm/sec

E/A of 0.6

Lateral mitral annular TDI 6.2 cm/sec

What is patient’s diastolic dysfunction?

Answer 1

Relaxation impaired

LAP is low/normal

Grade 1 Diastolic Dysfunction

Question 2

When is LAP elevated?

Answer 2

Above Grade 1 (Grade 2 and 3)

Question 3

What is 1/2 the spatial pulse length equal to?

Answer 3

Axial resolution

Question 4

What is the best to worst resolution:

Axial

Elevational

Lateral

Answer 4

Best = Axial

Lateral

Worst = Elevation

“Think of an ALE (Beer)”

Question 5

Which valve has divergent washing jets?

Answer 5

On-X bileaflet mechanical valve

Question 6

Which valve has convergent washing jets?

Answer 6

St. Jude Bileaflet mechanical valve

Question 7

Which valve has no washing jets, high gradients and has high durability

Answer 7

Starr Edwards

(Ball and cage valve)

Question 8

What valve has a large central jet through central aperture?

Answer 8

Medtronic Hall

Question 9

What valve has high embolization risk with single tilting disc?

Answer 9

Bjork Shiley valve

(Taken off market)

Question 10

What valve is an entire porcine aortic root?

Answer 10

Medtronic freestyle valve

Question 11

What is a valve that has small struts, central gap and thick leaflets?

Answer 11

Pericardial valve (Carpentier-Edwards)

Question 12

What is that? (At 2)

Answer 12

Middle cardiac vein

Question 13

What is the function of the matching layer of an ultrasound machine?

Answer 13

Improves transmission of ultraasound into soft tissue

Question 14

What would typically be seen of pulmonary vein stenosis? with PWD?

Answer 14

Pulmonary PWD has very high systolic and diastolic velocities

Question 15

What is seen with Mitral Stenosis on PWD of pulmonary veins?

Answer 15

Large A wave seen with pulmonaray venous PWD

Question 16

What is seen with Tricuspid Stenosis on PWD of hepatic veins?

Answer 16

Large A wave on Hepatic Venous PWD

Question 17

What is the e’ in RICM?

Answer 17

e’ <8 cm/sec

Question 18

What is the e’ of Constrictive Pericarditis?

Answer 18

e’ >12 cm /sec

Question 19

What is resonant frequency?

Answer 19

(resonant frequency) RF = Velocity / [2(Thickness)]

Question 20

What is the formula for acoustic impedence?

Answer 20

Acoustic Impedence (Z) = Density (P) x Velocity (V)

Question 21

What is a Q factor?

Answer 21

Q factor = Resonant Frequency / Bandwith

Remember, (resonant frequency) RF = Velocity / [2(Thickness)]

Question 22

What decreases the Q factor?

Answer 22

Damping Material will decrease Q factor.

How?

Damping material –> Widens the bandwidth

Remember

Q factor = Resonant Frequency / Bandwith

Remember, (resonant frequency) RF = Velocity / [2(Thickness)]

Question 23

What is the formula for the near field length?

Answer 23

(Near Field Length) Ln = r² / wavelength

Question 24

What type of canal defect is seen in Trisomy 21?

Answer 24

Complete AV canal defect

Question 25

What is seen in Barlow's Syndrome on echo?

Answer 25

Bileaflet prolapse Myxomatous Mitral valve

Question 26

What is seen from CV perspective of DiGeorge Syndrome?

Answer 26

Conotruncal Malformations (interrupted aortic aarch 50%) Persistent truncus arteriosus (34%) Tetralogy of Fallot VSD

Question 27

**What abnormality is seen with left sided obstruction:** 1. Parachute Mitral Valve 2. Supramitral Ring 3. Valvular Aortic Stenosis 4. Subaortic Stenosis 5. Aortic Coarctation

Answer 27

**Shone complex**

Question 28

What CV aspects have been seen with Turner Syndrome?

Answer 28

1. Coarctation of Aorta 2. Bicuspid AV 3. Aortic Stenosis 4. Hypoplastic Left Heart Syndrome

Question 29

If you see an oblique sinus, where will the pericardial fluid collect?

Answer 29

Adjacent to LAA

Question 30

If you see an transverse sinus, where will the pericardial fluid collect?

Answer 30

Transverse Sinus is seen in image "O"

Question 31

When you are providing echo for the structural heart procedures crossing the septum: 1. What image orients you inferior & superior?

Answer 31

**Bicaval** (Left = Inferior, Right = Superior) **RV inflow Outflow** (Determines anterior (near AV) or posterior)

Question 32

What is the most appropriate location for a wire to cross interatrial septum for a LAA closure device?

Answer 32

**Inferoposterior** region

Question 33

How do you differentiate pulmonic insufficiency vs. VSD?

Answer 33

PI = Diastolic flow VSD = Systolic flow

Question 34

What is the maximum Vena Contracta on CFD that is acceptable after watchman?

Answer 34

5mm

Question 35

What is an appropriate compression of watchman in the LAA after release?

Answer 35

Compressed 80-92% of its size is appropriate compression of the implant

Question 36

For a watchman, what is the appropriate **width** of the LAA ostium? For a watchman, what is the appropriate **length** of the LAA ostium?

Answer 36

*_Width_* must be **17 - 31 mm** *_Length_* must be **equal to or greater than the ostium width**

Question 37

When would you know if a Watchman implant was **too small** for the patient?

Answer 37

Compressed \>92%

Question 38

When would you know if a Watchman implant was **too large** for the patient?

Answer 38

If compressed **\<80%**, then the implant was too large for the patient