Mitral Valve

Question 1

What is the normal area of the mitral valve?

Answer 1

4 - 5 cm2

Question 2

The anterior mitral valve leaflet occupies what percentage of the mitral annulus?

Answer 2

33%

Question 3

The anterior mitral valve leaflet occupies what percentage of the mitral valve surface area?

Answer 3

50-66%

Question 4

The posterior mitral valve leaflet occupies what percentage of the mitral annulus

Answer 4

66%

Question 5

The posterior mitral valve leaflet occupies what percentage of the mitral valve surface area?

Answer 5

33-50%

Question 6

What is the cutoff for mean gradients in mild mitral stenosis?

Answer 6

< 5 mm Hg

Question 7

What pressure half-time defines severe mitral valve stenosis?

Answer 7

> 220 msec

Question 8

What is the range of valve areas in moderate mitral stenosis?

Answer 8

1.0 to 1.5 cm2

Question 9

What is cut-off for mean pressure gradient in severe mitral stenosis?

Answer 9

> 10 mm Hg

Question 10

What is the range of mean pressure gradients in moderate mitral stenosis

Answer 10

5 - 10 mm Hg

Question 11

What is the cut-off for pressure half-time in mild mitral stenosis?

Answer 11

< 150 msec

Question 12

What is the range of pressure half-times that defines moderate mitral stenosis?

Answer 12

150 - 220 msec

Question 13

What is the cut-off for vena contracta width that defines mild mitral regurgitation?

Answer 13

< 0.3 cm

Question 14

What is the cut-off for effective regurgitant orifice area (EROA) that defines severe mitral regurgitation?

Answer 14

> 0.40 cm2

Question 15

What is the cut-off for effective regurgitant orifice area (EROA) that defines mild mitral regurgitation?

Answer 15

< 0.20 cm2

Question 16

What is the range for effective regurgitant orifice area (EROA) that defines moderate mitral regurgitation?

Answer 16

0.20 - 0.40 cm2

Question 17

What is the cut-off for vena contracta width that defines severe mitral regurgitation?

Answer 17

> 0.70 cm

Question 18

What is the range for vena contracta width that defines moderate mitral regurgitation?

Answer 18

0.3 - 0.69 cm

Question 19

What is the cut-off for regurgitant volume that defines mild mitral regurgitation?

Answer 19

< 30 cm3

Question 20

What is the cut-off for regurgitant volume that defines severe mitral regurgitation?

Answer 20

> 60 cm3

Question 21

What is the range for regurgitant volume that defines moderate mitral regurgitation?

Answer 21

30 - 60 cm3

Question 22

What is the cut-off for regurgitant fraction that defines mild mitral regurgitation?

Answer 22

< 30%

Question 23

What is the cut-off for regurgitant fraction that defines severe mitral regurgitation?

Answer 23

> 50%

Question 24

What is the cut-off for regurgitant fraction that defines moderate mitral regurgitation?

Answer 24

30% - 50%

Question 25

The mitral valve area (MVA) can be calculated using pressure half-time by ______

Answer 25

MVA = 220 / (pressure half-time)

Question 26

The mitral valve area (MVA) can be calculated using deceleration time by _______

Answer 26

MVA = 759 / deceleration time (ms)

Question 27

Vena contracta, for determining the severity of mitral regurgitation, is best measured in which view?

Answer 27

The mid-esophageal long-axis view, which transects the mitral valve perpendicular to line of coaptation, is the optimal view to measure the vena contracta.

Question 28

Define Type I Carpentier classification for mitral regurgitation.

Answer 28

Type I lesions are characterized by normal mitral leaflet motion, and mitral regurgitation is caused by annular dilation or leaflet perforation.

Question 29

Define Type II Carpentier classification for mitral regurgitation

Answer 29

Type II lesions result from increased leaflet motion. This results from elongated or ruptured chordae allowing the affected leaflet to move beyond the coaption point and level of the annulus. The direction of the regurgitation is directed away from the pathologic leaflet.

Question 30

Define Type III Carpentier classification for mitral regurgitation.

Answer 30

Type III lesions are the result of restricted leaflet motion. This category can be further subdivided into IIIa and IIIb categories.

Question 31

Define Type IIIa Carpentier classification for mitral regurgitation.

Answer 31

In type IIIa lesions, leaflet motion is restricted in both systole and diastole.

Question 32

Define Type IIIb Carpentier classification for mitral regurgitation.

Answer 32

In type IIIb lesions, leaflet motion is restricted during systole only and is the result of displacement of one or both papillary muscles, or any segment of the ventricular wall, as found in ischemic mitral regurgitation.

Question 33

Which leaflet is usually involved in type IIIb Carpentier mitral regurgitation?

Answer 33

The posterior leaflet.

Question 34

Which commissure is seen in the far field in a transgastric basal view?

Answer 34

The anterolateral commissure (A1 / P1)

Question 35

Which commissure is seen in the near field in a transgastric basal view?

Answer 35

The posteromedial commissure (A3 / P3)

Question 36

Which mitral valve leaflets are visualized in a mid-esophageal four-chamber view?

Answer 36

A3 is usually seen closest to the ventricular septum and P1 is usually seen closest to the lateral wall.

Question 37

In the mid-esophageal commissural view, which leaftlets are visualized.

Answer 37

From right-to-left, P1….A2….P3