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ECHO 325 > Mitral Stenosis > Flashcards

Mitral Stenosis Flashcards

1
Q

The MV leaflets are composed of what three layers?

A

Fibrosa, spongiosa, atrialis

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2
Q

What is the purpose of the MV fibrosa layer?

A

Provides structural support and stiffness

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3
Q

What is the purpose of the MV spongiosa layer?

A

Provides flexibility to the valve

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4
Q

What is the MV atrialis layer?

A

Smooth layer composed of endocardium cells that line the atria

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5
Q

The posterior mitral leaflet is what size compared to the anterior mitral leaflet?

A

Half the length of the AML

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6
Q

MV scallops are labelled in which direction anatomically?

A

Lateral to medial

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7
Q

Which mitral leaflet is more susceptible to MAC (Mitral annular calcification)

A

Posterior mitral leaflet

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8
Q

What three things are the chordae tendinae responsible for?

A
  1. Anchoring the valve
  2. Maintaining ventricular geometry
  3. Preventing prolapse during systole
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9
Q

What pap muscle is more susceptible to complications from Ischemia or infarction?

A

Posteromedial papillary muscle

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10
Q

Which vessel supplies the posteromedial papillary muscle?

A

Posterior descending artery

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11
Q

Where does the posteromedial papillary muscle lay?

A

Along the inferior wall seen in PSAX adjacent to the septum

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12
Q

Which vessel supplies the anterolateral papillary muscle?

A

Left anterior descending artery and the circumflex artery

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13
Q

Where does the anterolateral papillary muscle lay?

A

Along the anterolateral wall seen in PSAX

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14
Q

Where does MV stenosis occur with rheumatic etiology?

A

Leaflet tips due to inflammation followed by scarring

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15
Q

Where does MV stenosis occur with degenerative etiology?

A

Basal annulus (usually PMAC) and progresses towards the leaflets

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16
Q

Where does MV stenosis occur with congenital etiology?

A

Subvalvular (single pap muscle with parachute valve or ASD/VSD defects)

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17
Q

Rheumatic MV stenosis can lead to what appearance of the orifice?

A

Fish mouth

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18
Q

What does doming of the anterior leaflet (hockey stick appearance) and thick chordae indicate?

A

Commissural (leaflet) fusion from rheumatic AS.

19
Q

What is the normal thickness of a mitral leaflet?

A

1-2 mm

20
Q

What are the most common primary benign tumors of the heart?

A

Myxoma

21
Q

What is Parachute MV?

A

MV stenosis caused by one papillary muscle instead of two.

22
Q

Parachute MV is associated with what?

A

Shone’s syndrome

23
Q

If someone has A-Fib how many beats should be captured to calculate mean PG?

A

3-5

24
Q

What is pressure half time?

A

The time taken for the early diastolic pressure gradient to fall to half of its original value.

25
Q

What kind of relationship does mitral valve area (MVA) have with pressure half time?

A

Inverse

26
Q

How is MVA derived?

A

220 ÷ pressure half time = MVA in cm squared

27
Q

What are sources of error for any valve?

A

Diameter and angle

28
Q

Which echo study is more sensitive to LA clots due to LAE?

A

TEE

29
Q

MS causes increased pulmonary venous pressure which leads to what?

A

Pulmonary arterial hypertension

30
Q

Longstanding pulmonary arterial hypertension causes irreversible what?

A

Pulmonary vascular resistance

31
Q

What are pharmacologic options to treat mitral valve stenosis?

A

Beta blockers, diuretics, anticoagulants, antiarrhythmics

32
Q

What do beta blockers do?

A

Slows HR and enhances filling time

33
Q

What are surgical treatments for mitral valve stenosis?

A

Valve repair and replacement

34
Q

What things are associated with degenerative MS (MAC)? (3)

A
  • Usual risk factors for atherosclerosis
  • Barlow’s disease
  • Marfan’s syndrome
34
Q

What type of pressure gradient is used for the MV and why?

A

Mean pressure gradient

The mean is used because MV inflow is not a single peak but the E and A, the result is an average pressure over diastole

34
Q

What are the values for MV mean gradient?

A

Mild = <

Mod = 5-10

Sev = >

35
Q

How does MS affect the decel slope and why?

A

The decel slope will be less steep than normal due to prolonged decline of early diastolic PG between LV and LA since the atria cannot empty as quickly through the stenosis.

36
Q

How is the MVA related to pressure half time?

A

Inversely

If MVA is decreased, pressure half time is increased.

37
Q

How do you calculate MVA area from decel time?

A
  1. Find pressure half time
    (P1/2t = 0.29/DT)
  2. Find MVA with P1/2t
    (MVA = 220/Phalftime)
38
Q

What happens to the a-wave in severe MS?

A

It disappears, atria cannot contract against high pressures.

39
Q

How can MVA be calculated using the continuity method?

A

By calculating the SV through another valve (usually AV)

40
Q

What is the equation for MVA continuity?

A

MVA = VTI(lvot) x CSA(lvot) / VTI(mv)

41
Q

When should MVA continuity NOT be used?

A

AR, MR, ASD or other significant shunt

42
Q

What are the values for MS using MVA?

A

Mild MS = >1.5 cm

Mod MS = 1 - 1.5 cm

Severe MS = < 1.0 cm

ECHO 325 (19 decks)

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