Mitral Stenosis Flashcards
What is MAC(Mitral Annular Calcification) or CMA?
Calcium deposits on the annulus, maybe leaflets
What artifact results from MAC?
Shadowing from the calcium deposits on the leaflets or annulus
What is the cause of MAC?
Degenerative process associated with aging, exact cause not fully known, diseases that stress the MV apparatus
What are the echo findings of MAC?
Bright echogenic reflections, shadowing can obscure view of leaflets, can extend into MV leaflets & AOV cusps
What is MS (Mitral Stenosis)?
Narrowing, thickening, and/or obstruction of the MV that impedes diastolic blood flow traveling from the left atrium through the MV into the LV
What is the #1 cause of MS?
Rheumatic Fever
Other causes of MS?
MAC, Congential, Left atrial mass or vegetation, prosthetic valve dysfunction, thrombus
What is the process of Rheumatic MS?
Leaflets & chordae become scarred & contracted, adhesions, fused commissures, restricted leaflet motion, leaflets become tethered, orifice becomes funnel shaped and narrowed, leads to LA pressure * Stenosis is at leaflet tips
What is the MS appearance on echo?
Hockey stick appearance of the anterior leaflet(diastolic doming), thickening of leaflets >3mm.
What is the hockey stick appearance of the anterior MV leaflet caused by?
Increased pressure in the proximal chamber pushing on the undersurface of the tethered leaflets while they are open
What is the MS murmur?
Low pitched rumbling diastolic murmur with opening snap
What are MS symptoms?
SOB, Dyspnea on exertion, hemoptysis, CP, Palpitations, fatigue, heart failure if untreated
What kind of load does MS have?
Increased LA pressure overload, which
causes LA enlargement»_space;a-fib, Overload of pressure in lungs = PHTN & RV, Increased HR = shorter diasatolic filling period and if left untreated can lead to right heart failure
Other complications due to MS?
- Thrombus in LA or LAA due to increased LA size & stasis of flow from reduced LA function
- MR due to annular stretching from LAE
- PHTN due to increased resistance to pulmonary venous flow
- Decreased CO
- Heart Failure
What is Smoke in LAA?
Spontaneous echo contrast- swirling effect and stagnant blood in LAA
2D findings of MS?
Echogenic leaflets, restricted leaflet motion, Hockey stick appearance, diastolic doming, fusion of commissures, smoke in LA/LAA, LAE
M-Mode findings of MS?
E-F slope & A wave decreased, thickened leaflets, anterior motion of the PMVL, reduced D-E leaflet excursion, LAE, paradoxical septal motion
What color doppler findings of MS do you see?
Blue Candle flame jet, turbulent diastolic flow that travels from LA thru MV while open into LV
Which is best view to assess MS?
Apical 4
What are Spectral doppler findings of MS?
Increased peak E velocity, decreased E-F
slope, flatter the slope = more severe stenosis, P1/2T increases = more severe
When MS is long standing what may happen?
PHTN
MS with assoc PHTN, what will you see on 2D echo?
RV hypertrophy, RV dilation. Flattened IVS from increased pressure in RV (flatness persists) best seen in SAX. Paradoxical wall motion may result. D-Shape LV in diastole and systole
MS with assoc PHTN what will you see on M-Mode?
RV hypertrophy of RVFW, RVE, Flattened IVS, small LV with possible paradoxical septal motion, absent ‘a’ wave on the PV (normal would be 2.7mm), mid systolic closure of PV creating flying W
Normal IVC diameter?
1.2 - 2.3 cm
Normal hepatic vein diameter?
0.5 - 1.1 cm
What equation used for MS?
P1/2T ( MVA=220/P1/2T) or
P1/2T=Mdt x 0.29
Normal MVA
Mild MS
Moderate MS
Severe MS
4-6 cm squared
>1.5 cm squared
1.0-1.5 cm squared
<1.0 cm squared
Normal P1/2T
Mild MS
Moderate MS
Severe MS
30-60 msec
90-150 msec
150-219 msec
>220 msec
Anatominc MVA > Doppler MVA? T or F
True
Planimetery MVA?
PSAX, enlarge MV at level of leaflet tips, freeze, trace opening of valve during
smallest opening at early diastole.
What is Gorlin Method?
Cath lab method of finding MVA
