Mitral Valve Flashcards
what should you always report with the MV gradient?
HR
Diagnosis?
MS
why do a TEE before Mitral valvuloplasty for rhematic MS?
r/o LA thrombus or >2+ MR
Wilkins score components and when to send to vavluloplasty
<8
valve mobilty
subvalvular thickening
valve thickening
calcification
can you use PHT to calculate MVA 24-48h after valvuloplasty?
no
which slope do you use to calc MVA if you have 2 deceleration slopes?
the one with the longer duration
when can you not use the continuity eq’n to calculate MVA?
> mild MR or AR
PISA Eq’n for MVA
Diastolic Flow/Vmax
(Diastolic Flow = 6.28 x (r^2) x Vr x a/180)
if you use continuity eq’n to calculate MS, what happens if there is MR? AR?
MR–> overestimate MS
AR—> Underestimate MS
when does an increased PHT not mean MS?
abnormal relaxation (E velocity not increased) or MG normal
What is MV PHT shortened by?
AR and Decreased LV compliance
Diagnosis
Radiation MS
Diagnosis
Parachute MS
Diagnosis
Medication Induced MS (small/retracted leaflets with thick tips
Diagnosis
MVP
Diagnosis
SAM
Definition of MVP
>2mm systolic displacement of one or both leaflets into LA below plane of mitral annulus
If your MV leaflet in PLAX looks like its prolapsing into LA, but the distant from annular plan to prolapsed leaflet is <2mm- what do you call it?
bowing
At what ERO is ischemic MR severe? organic?
ischemic–> ERO> .2 cm^2
organic–> ERO > .4
which MR is more severe?
the top one (more dense jet, holosystolic vs. end-systolic only)
name 5 SPECIFIC signs of severe MR
VC > .7
large central jet or wall-hugging/LA-swirling jet
Large flow convergence
systolic flow reversal in PV
prominent flail or ruptured pap
Name 3 SUPPORTIVE (not specific) signs of severe MR
Dense/triangular CW of MR
E > 1.2 m/s
Large LA/LV
ERO, RVol, RF indicating mild and severe MR
ERO <.2, >0.4
RVol <30, > 60
RF <30, > 50%
Diagnosis in each picture
PV systolic damping and Systolic flow reversal (from severe MR- goes UNDER the baseline)
VC in mild MR? Severe MR?
<.3 cm
>.7 cm
Diagnosis
Flail P2 (MV)
Diagnosis
SAM
(Posteriorly directed jet for severe MR on TEE- ALWAYS LOOK FOR THE SAM)
In patients w/ SAM (LVOT obstruction), if they have failed BB/CCB, what other negative inotrope can be used?
disopyramide
3 characteristics of Rheumatic MS
calcified leaflet tips
fish mouth
hockey stick leaflet in PLAX
DT x 0.29 = ?
PHT
750/DT = ?
MVA
Normal range for peak E wave velocity
.8-1
how severe cna MR be if A > E wave?
not very severe
what is NOT ok to use after MV valvuloplasty to obtain MVA? what DO you use?
dont use PHT or Planimetry!
DO use Continuity eq’n
