Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medical > MR/MS > Flashcards

MR/MS Flashcards

1
Q

Describe the key features of rheumatic MS?

A
  • Commisural Fusion
    • ​leaflet: thick at tips
    • Chordae: thick/retracted
    • Short posterior leaflet
    • Calcification: late
    • MS > MR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the key features of degenerative MS?

A
  • Annular calcification
    • ​Leaflet: thick at base
    • Associated with atherosclerosis, HTN, AS
    • MR > MS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the methods for determining MVA in MS?

A
  • Planimetry
  • Continuity equation
  • PHT
  • PISA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the formula for calculating MVA using PHT?

A

MVA = 220 / PHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define PHT

A

time required for the gradient between the LA and the LV to fall to one half of its initial value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What PHT correlates with severe MS?

A
  • 150 ms
    • 220/150 = 1.46 cm2
    • < 1.5 cm2 –> severe MS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Under what conditions is PHT assessment of MS inaccurate?

A
  • AR (short PHT)
    • will rapidly increase the LV diastolic pressure and shorten PHT –> underestimation of MS (overestimation of MVA)
  • Sudden changes in LA-LV compliance
    • immediately following BMVP
  • Diastolic dysfunction
    • increased LV filling pressure
  • ASD

****less accurate in calcific MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What group of patients should PHT assessment of MS be avoided?

A

Elderly patients with calcific, degnerative MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you calculate MVA using the continuity equation?

A

MVA = LVOTVTI x LVOTarea / MVVTI

  • MVA = LVOT D2 x 0.785 x ( LVOTVTI / MVVTI )
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What situations make use of the continuity equation unreliable in assessment of MS?

A
  • MR
  • AR
  • A-Fib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is one change in the echo settings that is useful when calculating PISA?

A

shift baseline (aliasing velocity) in the direction of the flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the formula for calculating MVA using PISA?

A

MVA = 6.28 x r2 x Vr / Peak Vmax x angle/180

  • r = radius of convergence hemisphere
  • Vr = aliasing velocity c/s
  • Vmax = peak CWD velocity of mitral inflow c/s
  • angle = opening angle of mitral leaflets relative to flow direction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the Class I ASE recommendations for MVA?

A
  • Planimetry
  • PHT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the Class 2 ASE recommendations for MVA?

A
  • PISA
  • Continuity equation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the best/most reproducible method for assessing MVA in rheumatic MS?

A

3D planimetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the best/most reproducible method for assessing MVA in degenerative MS?

A

Continuity equation > 3D planimetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the levels of severity for MS: MVA

A
  • Progressive > 1.5 cm2
  • Severe 1.0-1.5 cm2
  • Very severe < 1.0 cm2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the levels of severity for MS: MG

A
  • Progressive < 5 mmHg
  • Severe 5-10 mmHg
  • Very severe > 10 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the levels of severity for MS: PHT

A
  • Severe > 150
  • Very Severe > 220
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the levels of severity for MS: PASP

A
  • Severe > 30 (50) mmHg
  • Very severe > 30 (70) mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What factors should be considered in evaluation for balloon valvuloplasty of MS?

A
  • Valve pliable:
    • commissural calcification
    • Wilkins/Abascal Score < 8
      • Mobility (1-4)
      • Thickening (1-4)
      • Calcification (1-4)
      • Sub-valvular thickening (1-4)
  • MR < 2+
  • No thrombus in LAA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the indications for PMBV?

A
  • Symptoms
  • Severe MS
  • Feasibile valvuloplasty
  • Asymptomatic + Pulmonary hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are unusual (acquired) etiologies of MS?

A
  • Lupus
  • Carcinoid
  • Drugs
  • Radiation
  • Infiltrative (Maroteaux-Lamy)
    • Mucopolysaccharidosis Type IV
  • Iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are unusual (congenital) etiologies of MS?

A
  • Luttembacher (ASD + MS)
  • Shone (AS + MS + Coarctation)
  • Supravalvular membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the formula to calculate PHT from deceleration time (DT)?

A

PHT = 0.29 x Deceleration Time (DT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is vena contracta?

A
  • narrowest width of the regurgitant jet, measured using color doppler flow imaging
  • both proximal acceleration region and the distal jet expansion should be seen to ensure the narrowest segment of the jet is measured
    • < 0.3 cm = mild MR
    • > 0.7 cm = severe MR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the four components of the mitral valve?

A
  1. mitral leaflets (anterior and posterior)
  2. mitral annulus
  3. subvalvular structure (including both chordae tendinae and papillary muscles)
  4. LV wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the categories of MR?

A
  • Primary (predominantly degenerative)
    • lesions of the mitral leaflets and subvalvular apparatus
  • Secondary (functional)
    • annular or LV dilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are causes of primary MR?

A
  • Myxomatous valve disease
    • prolapse
    • Barlow’s syndrome
    • Elongated/Ruptured/Flail Chordae
  • Degenerative diseases:
    • Thickened/calcified MV apparatus with restricted mobility and poor coaptation
    • Ruptured chordae/flail valve
  • Infectious etiology/endocarditis
    • Vegetations
    • Perforation
    • Leaflet aneurysm
    • Abscess
  • Inflammatory
    • Rheumatic
    • Collagen vascular diseases
    • Radiation
    • Drugs
  • Congenital
    • Cleft valve
    • Parachute mitral valve
    • Blood cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the most common cause of MR?

What is the pathophysiology that leads to MR?

A
  • myxomatous degeneration
  • localized, fibroelastic deficiency due to abnormalities in connective tissue –> results in chordal thinning and elongation and subsequent MV prolapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What occurs in Barlows disease?

A

MR secondary to diffuse, myxoid degeneration of the MV –> excess tissue in multiple valve segments, including leaflets, chordae, and annular dilation

**myoxoid degneration: degenerative process in which the connective tissues are replaced by a gelatinous or mucoid substance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the mechanism of MR in secondary or functional MR?

A

LV dilatation and/or dysfunction –> mitral annular dilation and impaired leaflet mobility or tethering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does the Carepntier classificaiton system classify MR types?

A
  • focus on differences in leaflet mobility as the cause of leaflet malcoaptation and MR
  • 3 types
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Define the Carpentier classification - Type I

A
  • Dysfunction –> normal leaflet motion (poor leaflet coptation)
  • Lesions –> isolated annular dilation + leaflet perforation / tear
  • Etiology
    • Dilated cardiomyopathy
    • Ischemic cardiomyopathy
    • Congenital
    • Endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define the Carpentier classification - Type II

A
  • Dysfunction –> excessive leaflet mobility (leaflet prolapse) above the mitral annulus plane
  • Lesions –>
    • elongation / rupture chordae
    • elongation / rupture of papillary muscle
  • Etiology
    • Degenerative valve disease
      • fibroelastic deficiency
      • Barlow’s disease
      • Marfan’s disease
    • Ischemic Cardiomyopathy
    • Endocarditis
    • Ehler-Danlos syndrome
    • Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Define the Carpentier classification - Type IIIa

A
  • Dysfunction –> restricted leaflet motions (diastole and systole - opening)
  • Lesions –>
    • leaflet calcification / thickening / retraction
    • chordal fusion / thickening / retraction
    • commisural fusion
  • Etiology –>
    • Carcinoid heart disease
    • Hypereosinophilic syndrome
    • Radiation
    • Rheumatic heart disease
    • Mucopolysaccharidosis
    • SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the best views for evaluating vena contracta (in MR) on TTE and TEE?

A
  • TTE: parasternal long-axis view
  • TEE: long-axis view at 120
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In what other clinical situation is Sgarbossa criteria utilized for the diagnosis of MI?

A

RV pacing (also demonstrates LBBB on EKG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the Doppler parameters used in the assessment of MR severity?

A
  • Color flow jet area
  • Mitral inflow - PW
  • Jet density - CW
  • Jet contour - CW
  • Pulmonary vein flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does the image show?

What is the treatment of choice?

A
  • SAM of the mitral valve - consistent with LVOTO
  • Nondihydropyridine CCB’s (Verapamil) or BB’s
    • Afterload reducing agents (Lisinopril and Amlodipine) and diuretics are likely to exacerbate the obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the pathophysiology of hemoptysis in MS cases?

A

elevated postcapillary pulmonary pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Describe MV leaflet scallops visualized in A2C view?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Describe MV leaflet scallops visualized in A4C view?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are causes of mitral regurgitation secondary to systolic anterior motion?

A
  • hypertrophic cardiomyopathy
  • hypertensive heart disease with prominent basal septum
  • acute anterior infarcts with hyperdynamic compensatory function
  • apical ballooning syndrome with a hyperdynamic base
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the components of the Wilkins score for MS/PMBV?

A
  • Leaflet/valvular
    • thickening
    • mobility
    • calcificaiton
  • Subvalvular thickening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the diagnosis?

A
  • Flail P2 scallop
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the formula for PHT in MS, utilizing deceleration time?

A

PHT = 0.29 x DT

MVA = 220/PHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe MV leaflet scallops visualized in PLAX view?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the mechanism of successful mitral valuloplasty?

A

commisural separation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Describe scallop anatomy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Describe MV leaflet scallops visualized in parasternal SAX view?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is one major contraindication to percutaneous MitraClip repair?

A

leaflet calcification at the device landing zone (in this case A2 and P2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Describe scallop anatomy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Describe MV leaflet scallops visualized in these views:

  • PLAX
  • PSAX
  • AP4
  • AP2
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the problem with heavy calcification in patients undergoing PMBV?

A
  • Lower procedural success rate
  • Higher incidence of significant MR
56
Q

What is the formula for RV (in MR evaluation)?

A

RV = EROA x regurgitant VTI

57
Q

What is a possible diagnosis in Systolic anterior motion (SAM)-related MR with an anteriorly directed regurgitant jet?

A

Superimposed organic MV pathology - likely a flail posterior leaflet

58
Q

What is the most common angle of mitral valve leaflets at the time of PISA (in MR evaluation)?

What if the jet creates an angle other than 180?

A
  • 180 degrees
  • Angle adjustment (angle/180)
    • frequently occurs when jet originates from commisures, which are in close proximity to the LV wall
    • not enough space for a full hemisphere to form
59
Q

What is the TEE - 60 degree called (in MR evaluation)?

A

commisural view

60
Q

What is the diagnosis?

What is the findings that support the diagnosis?

What will clinical examination (auscultation) reveal?

A
  • Rheumatic MS (given history of multiple infections as a child
  • Supportive signs on imaging:
    • hockey-stick defomrity of the anterior MV leaflet
    • incomplete opening of the posterior MV leaflet
    • visible mitral inflow acceleration
    • CW doppler is consistent with severe MS (MG = 16 mmHg)
  • Opening snap occurring early after A2
61
Q

Describe the ausculatory findings in MS in relation to A2

A
  • Interval between the second heart sound (A2) and the opening snap reflects the isovolumic relaxation time
    • typically shorter with higher left atrial pressures
    • the shorter the A2-opening snap interval –> more severe the MS
      *
62
Q
  • young patient with lightheadedness associated with physical activity
  • 2/6 systolic murmur at the left parasternal border
  • increases with Valsalva maneuver
  • orthostatic BP’s normal
A

murmur suggestive of dynamic LV outflow obstruction

63
Q

What is the best line for PHT tracing (in MS evaluation)?

A
  • Number 2
    • Number 1 is incorrect as this will be reflective of both left atrial and ventricular pressure, not only mitral stenosis
64
Q
  • young patient with worsening dyspnea on exertion
  • systolic murmur over precordial area
  • sustained apical impulse
  • normal splitting of 2nd heart sound
  • increases with squat to stand maneuver
A

hypertrophic cardiomyopathy with dynamic outflow obstruction

65
Q

What is the optimal aliasing velocity for PISA in MR evaluation?

A

30-40 cm/s

  • values greater –> small radii
  • lower values –> identify isovelocity shells too far from the regurgitant orifice, where surface is no longer a hemisphere
66
Q

What are the Quantitative parameters used in the assessment of MR severity?

A
  • VC width (cm)
  • R Vol (ml/beat)
  • RF (%)
  • EROA (cm2)
67
Q

What is the typical leaflet abnormality and doppler appearance of Systolic anterior motion (SAM)-related MR?

A

Posteriorly directed regurgitant jet

  • if anteriorly directed –> consider superimposed organic MV pathology
68
Q

Central jets are typically seen with this type of MR?

Etiology?

A
  • Secondary (functional) MR
  • LV dilation
69
Q

What is the relation to mitral gradient and HR?

A

significantly increased with increasing HR’s

70
Q

When should your PISA radius be measured (in MR evaluation)?

A
  • Should be selected to match the timing of the peak MR velocity
  • Usuually occurring close to the T wave on ECG
71
Q

What view should be utilized in PISA (MR evaluation)?

A

Any view that allows optimal Doppler alignment (parallel with the flow)

  • eccentric jets may require parasternal and subcostal views for better window alignment
72
Q

Ischemic MR typically results in what pattern of MR jet?

A

eccentric, posteriorly directed jet

73
Q

Describe the type of MR jet caused by MVP?

A

eccentric jet, directed away from the affected leaflet

74
Q

Within 24 hours of a STEMI, when should an ACE inhibitor be initiated?

A
  • STEMI with an anterior location
  • Heart Failure
  • EF < 40%
75
Q

Define the Carpentier Classification - Type IIIb

A
  • Dysfunction –> restricted leaflet motion (systole, closure)
  • Lesions –>
    • LV dilatation / aneurysm
    • papillary muscle displacement
    • chordae tethering
  • Etiology
    • Ischemic / Dilated Cardiomyopathy
76
Q

What is the underlying mechanism for EKG changes with TCA overdose?

A

excess sodium channel blockade

77
Q

What are the two major side effects of sodium-channel blocker poisoning?

A
  • Seizures
  • Ventricular dysrhythmias

*** due to blockade of sodium channels in the CNS and myocardium

78
Q

What are the major EKG findings in TCA overdose?

A
  • Sodium channel blockade
    • Interventricular conduction delay (QRS > 100ms in lead II)
    • RAD
      • Terminal R wave > 3 mm in aVR
      • R/S ratio > 0.7 in aVR
  • Muscarinic (M1) receptor blockade
    • sinus tachycardia
  • Potassium channel inhibition
    • QTc prolongation
79
Q

What additional vavlvular abnormality makes PMBV ineffective?

80
Q
A

TCA overdose

  • sinus tachycardia with 1st degree AV block (p waves hidden in the T waves, best seen in V1-V2)
  • Widened QRS
  • Positive R’ wave in aVR
81
Q

What is the pathophysiologic mechanism of chronic MR?

A

Volume overload of the LV –>

ventricular and atrial remodeling via eccentric hypertrophy

  • dilation of the LV without increased wall thickness
  • increase in LV size is adaptive for increasing LV volume without an increase in diastolic filling pressure
  • increase in ventricular compliance and maintaining stroke volume and cardiac output
82
Q

What is the pathophysiologic mechanism of chronic MR?

A

Volume overload of the LV –>

ventricular and atrial remodeling via eccentric hypertrophy

  • dilation of the LV without increased wall thickness
  • increase in LV size is adaptive for increasing LV volume without an increase in diastolic filling pressure
  • increase in ventricular compliance and maintaining stroke volume and cardiac output
83
Q

This finding is the major influence on clinical manifestations of chronic MR?

A

elevation of LA pressure (leads to)

  • pulmonary congestion
  • pulmonary hypertension
  • A-fib
84
Q

What are common causes of acute MR?

A
  • chordal or papillary muscle rupture
  • Infective endocarditis
85
Q

What is the pathophysiology of acute MR?

A
  • sudden increase in LA and ventricular volume in the absence of LV or atrial dilation –>
  • Pulmonary venous pressure rises rapidly –> pulmonary edema –>
  • LV stroke volume is reduced –>
  • systemic hypotension despite compensatory increase in HR to maintain Stroke Volume
86
Q

Describe the physical examination findings of MR?

A
  • Holosystolic
  • best heard at the apical or left midclavicular region
  • Worsened:
    • left lateral decubitus position
    • increased afterload (handgrip)
  • Radiation is highly variable depending on jet direction
  • Mid-systolic click may be heard if MVP present
  • S3 may be present if associated with LV systolic dysfunction
87
Q

What is the diagnosis in patients with a central MR jet origin with normal valve structure but restricted mobility and LV dilation?

A

functional (secondary) MR

88
Q

What associated conditions should be documented in Echo evaluation of MR?

A
  • Pulmonary Hypertension
  • TR
  • LA dilation
  • LV dilation
  • LV systolic dysfunction

***Class I recommendation

89
Q

What is the most common technique for quantitating MR severity?

A

Doppler Echocardiography

90
Q

What congenital anomaloy is associated with unicuspid aortic valve?

A

hypoplastic left heart syndrome

91
Q
A

unicuspid aortic valve

92
Q

Most common cause of AS in developed countries

A

Degenerative calcific aortic stenosis

93
Q

What is the normal LA volume for men/women?

Mildly abnormal?

Moderately abnormal?

Severely abnormal ?

A
  • Normal: 22 mL/m2 +/- 6
  • Mild: 29-33 mL/m2
  • Moderate: 34-39 mL/m2
  • Severe: > 40 mL/m2
94
Q

What are the Class I indications for MV surgery in Severe, Asymptomatic (stage C) MR?

A

LVEF 30% - ≤ 60%

or

LVESD ≥ 40 mm

**Stage C2

95
Q

What are the next steps/paramters to evaluate in a patient with Primary, Severe, Asymptomatic (Stage C) MR?

A
  • Stage C2 –> MV surgery (class I)
    • LVEF 30% - ≤ 60%

or

LVESD ≥ 40 mm

  • Stage C1 (repair vs. surgery vs. monitoring)
    • LVEF > 60%

and

LVESD < 40 mm

  • Stage C1 (repair vs. monitoring)
    • New-onset AF

or

PASP > 50 mmHg

96
Q

What are the next steps/paramters to evaluate in a patient with Primary, Severe, Asymptomatic (Stage C1) MR with LVEF > 60% and LVESD < 40 mm?

A
  • Progressive increase in LVESD

or

Decrease in EF

* MV surgery (IIa) * Likelihood of successful repair \> 95% and expected mortality \< 1%
* Yes --\> MV repair (IIa)
* No --\> Periodic monitoring
97
Q

What is the net effect of an IABP?

A
  • increase in mean arterial pressure (MAP)
  • augmented ventricular stroke volume
98
Q
A
  • Prolapse of the posterior mitral valve leaflet on TEE
  • TEE 3D reconstruction of the MV; viewed through the left atrium (surgeon’s view)
    • Barlow’s disease with prolapsed segment along lateral scallop of the posterior leaflet
  • MV repair
    • BD-resection of redundant tissue and insertion of a mitral ring
99
Q
A

Prolapse of posterior MV leaflet with severe MR

100
Q
A

Perforated anterior mitral valve leaflet

101
Q
A

Anterior mitral valve leaflet prolapse

102
Q

What specific defect leads to MR in rheumatic mitral disease?

A
  • shortening of the posterior mitral leaflet
  • restricted motion of the anterior mitral leaflet
  • usually producing a centrally or posteriorly directed jet
103
Q
A

isolated cleft of anterior mitral valve leaflet on 3d TEE

104
Q
A

Isolated cleft of anterior MV leaflet on TTE, parasternal short axis

105
Q

What are causes of secondary/functional MR?

A
  • Dilated LV
    • dilated MV annulus and poor coaptation
  • Segmental wall-motion abnormality with tethering of a leaflet and ecreased coaptation (usually ischemic in origin)
  • Ruptured papillary muscle
  • Systolic anterior motion (SAM) of valvular apparatus
106
Q

Describe the mechanism for functiona/secondary MR

107
Q

What quantitative measures are more accurate in secondary/functional MR?

A
  • EROA
  • RF
  • RV - not as accurate, underestimates severity
108
Q
A

Acute MR with rupture of posteromedial papillary muscle

TEE - mid-esophageal 2-chamber view

109
Q

What patients are at increased risk to develop post-MI acute MR?

A
  • Single blood supply to a papillary muscle (more commonly the posteromedial papillary muscle)
  • Require urgent surgical intervention
110
Q

Describe anatomy of mitral valve

111
Q

What scallops are visible?

112
Q

Describe scallop anatomy

113
Q

What is the next step after identifying dynamic LVOT obstruction + severe MR intraoperatively?

A

Reassess intraoperatively after coming off of cardiac bypass

114
Q

Describe ischemic MR

A
  • associated with a posterior regurgitant jet
  • posterior leaflet tethering
  • anterior leaflet override
115
Q

What EROA in ischemic MR is associated with a poor prognosis?

A

EROA > 0.20 cm2

116
Q

What is the current recommendation for mitral valve correction in IMR?

A

moderate or greater MR –> should be corrected at time of surgery

117
Q

What are medications that can be used to decrease the effects of LVOT obstruction with SAM and MR?

What effects of these medications make them effective?

A
  • BB
  • Verapamil
  • Disopyramide
  • negative chronotropic and inotropic agents
118
Q

What is the surgical management for LVOT/SAM/MR?

A

septal reduction therapy

119
Q

What medications and/or actions will make LVOTO/SAM/MR worse?

A
  • Afterload reduction (Lisinopril)
  • Valsalva maneuver
120
Q

What is the diagnosis?

A

flail P2 scallop with severe MR

121
Q

What LVEF likley reflects LV dysfunction in patients with severe MR?

A

LVEF < 60%

  • indication for surgical intervention
122
Q

When is restriction from competitive sports recommended in patients with MVP?

A
  • moderate LV enlargement
  • LV dysfunction
  • uncontrolled tachyarrhythmias
  • unexplained syncope
  • aortic root enlargement

****Regular exercise is recommended

123
Q

Which leaflet has a higher success rate for repair in MVP?

A

posterior >> anterior

124
Q

What is the likelihood of repair for posterior MVP?

Expected mortality with surgical intervention?

A
  • > 90%
  • < 1%
125
Q

Describe the image

A
  • Repaired mitral valve
    • Edge-to-edge (Alifieri) repair of the mitral valve
    • anterior and posterior leaflets are sutured together in the mid portion, giving the typical appearance of a double-orifice mitral valve
126
Q

This is a common finding after septal myectomy for SAM/MR

A
  • corrected by surgical intervention on the LVOT
  • residual MR
  • color jet on septal wall represents flow from a coronary-LV fistula
    • common benign finding after septal myectomy procedures
127
Q

What is the success rate of mitral valve repair in experienced centers?

A

> 90% at 10 years

128
Q

What is one complication that may ocur following myectomy for SAM/MR?

A

residual MR –> necessitating mitral valve procedure

129
Q

What is one potential complication of an edge-to-edge MV repair (Alifieri stitch) postmyectomy?

A

double orifice mitral valve –> relative mitral stenosis

130
Q

Describe an MR murmur

A
  • laterally displaced
  • apical impulse
  • 4/6 holosystolic
  • increases during inspiration
131
Q

What is the severity scale for EROA in MR?

A
  • Mild < 0.2 cm2
  • Moderate
    • Grade II - 0.2-0.29 cm2
    • Grade III - 0.30-0.39 cm2
  • Severe > 0.40 cm2
132
Q

What is the severity scale for Regurgitant Volume (RVol) in MR?

A
  • Mild < 30 mL
  • Moderate
    • Grade II - 30-44 mL
    • Grade III - 45-59 mL
  • Severe > 60 mL
    • ****for severe MR may be lower in low flow conditions
133
Q

What is the severity scale for Regurgitant Fraction (RF) in MR?

A
  • Mild < 30%
  • Moderate
    • Grade II - 30-39%
    • Grade III - 40-49%
  • Severe > 50%
134
Q

What are the specific criteria for mild MR diagnosis?

A
  • Small, narrow central jet
  • VC < 0.30 cm
  • PISA radius absent or < 0.30 cm (at Nyquist 30-40 cm/s)
  • Mitral A wave dominant inflow
  • Soft or incomplete jet by CW doppler
  • Normal LV and LA size

****2-3 criteria –> perform quantitative methods (EROA, RV, RF)

135
Q

What are the specific criteria for severe MR diagnosis?

A
  • Flail leaflet
  • VC < 0.70 cm or VCA > 0.50 cm2
  • PISA radius absent or > 1.0 cm (at Nyquist 30-40 cm/s)
  • Central large jet > 50% of LA area
  • Pulmonary vein systolic flow reversal
  • Enlarged LV with normal function

****2-3 criteria –> perform quantitative methods (EROA, RV, RF)

Medical (69 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions