MS/MR

Question 1

What are common reasons for primary MR?

Answer 1

MVP myxomatous changes, degenerative changes, infectious, inflammatory, or congenital (all leaflet abnormalities)

Question 2

What are common reasons for secondary MR?

Answer 2

Ischemic 2/2 CAD, nonischemic cardiomyopathy, and annular dilation (all due to some sort of ventricular remodeling)

Question 3

What is a Carpentier Type 1 defect?

Answer 3

MR secondary to annular dilation (centrally directed jet) or MR secondary to a perforated segment (usually A2 or P3) which leads to a central MR jet; note there is normal leaflet motion

Question 4

What is a Carpentier Type II defect?

Answer 4

Excessive leaflet motion; MR 2/2 leaflet prolapse or flail; usually produces an eccentric jet

Question 5

What is a Carpentier Type III defect?

Answer 5

Restricted leaflet motion; Type IIIa = leaflet motion is restricted in both systole and diastole (thickening or fusion); Type IIIb = leaflet motion is only restricted in systole (LV/LA dilation)

Question 6

What are the risk factors for SAM post MV repair?

Answer 6

1. C-sept distance < 25mm 2. AL/PL < 1.3 3. Aorto-mitral angle < 120 4. LVEDd<45mm

Question 7

What are the 3 common types of mitral valve repairs?

Answer 7

Neochordae insertion, triangular resection, and quadrangular resection

Question 8

What are some complications from MV repair/replacement that you should keep in mind?

Answer 8

AV groove disruption (catastrophic) + LCX occlusion/kinking + AV leaflet damage

Question 9

What is the most common cause of mitral stenosis in the world? #2?

Answer 9

Rheumatic fever is the most common followed by calcific mitral stenosis (MAC)

Question 10

What are some causes of congenital mitral stenosis?

Answer 10

Parachute mitral valve or cor triatriatum sinister (membrane that divides the LA)

Question 11

What is cor triatriatum sinister associated with?

Answer 11

ASD, VSD, PAPVR and TAPVR

Question 12

What are risk factors for mitral stenosis?

Answer 12

Untreated strep infections + aging + radiation therapy + medications

Question 13

What is the most common arrhythmia associated with mitral stenosis?

Answer 13

Atrial fibrillation (2/2 atrial dilation)

Question 14

What is the cutoff for moderate mitral stenosis?

Answer 14

Valve area 1.0-1.5 cm2 + mean gradient 5-10 mmHg + pulmonary artery pressure 30-50 mmHg

Question 15

What is the pharmacologic treatment for mitral stenosis?

Answer 15

Everything is to alleviate symptoms: lengthen diastole (beta block, CCB) + relieve pulm HTN + address RV dysfunction + avoid tachycardia

Question 16

What does the evidence say about patients undergoing noncardiac surgery with asymptomatic mitral stenosis?

Answer 16

If asymptomatic with moderate or worse mitral stenosis + less than severe pulm HTN, Class 2a recommendation to perform elective noncardiac surgery

Question 17

What are the non-pharmacologic treatment options for mitral stenosis?

Answer 17

Percutaneous mitral balloon commissurotomy or surgery

Question 18

What are the indications for mitral valve replacement for mitral stenosis?

Answer 18

Severe MS with NYHA Class 3 or 4 who cannot undergo percutaneous mitral valvulotomy + asymptomatic patients with severe MS and severe pulm HTN

Question 19

What are the indications for percutaneous mitral balloon valvuloplasty?

Answer 19

1. Symptomatic patients with less than severe mitral valve stenosis
2. Asymptomatic patients with severe MS
3. Severe MS with new-onset atrial fibrillation
4. Patients who cannot undergo surgery for mitral valve replacement

Question 20

What are complications for untreated mitral stenosis?

Answer 20

Atrial fibrillation + pulmonary HTN + right-sided heart failure + thromboembolic disease and stroke (secondary to atrial fibrillation)