Prosthetic Valves

Question 1

which is pathologic and which is functional AV stenosis, why?

Answer 1

Left= pathologic (rounded doppler/AT>100

Right= functional

Question 2

Less than or equal to how much = AV prosthesis FUNCTIONAL stenosis?

Answer 2

100 m/s

(so longer AT = pathologic)

Question 3

another name for dimensionless index?

Answer 3

Doppler velocity index

Question 4

eq’n for Dimensionless Index for AV Prosthesis (and types of doppler to use in numerator and denominator)?

Answer 4

DI= Velocity lvot/Velocity avp= TVI LVOT/TVI AVP

(LVOT w/ PW, AVP w/ CW)

Question 5

Dimensionless Index = pathologic obstruction of Prosthetic OR Native AV?

Answer 5

< 0.25

Question 6

3 things that define FUNCTIONAL obstruciton of a prosthetic valve

Answer 6

PPM

high flow

pressure recovery

Question 7

Use continuity eq’n to calculate EOA of AVP

Answer 7

AVP Area = SV/TVI AVP

(SV = Alvot x TVI LVOT)

Question 8

eq’n for indexed EOA (iEOA); what can it help differentiate for a prostethic valve?

Answer 8

iEOA = EOA/BSA

functional vs. pathologic obstruction

Question 9

which 2 variables in severeity if AVP obstruction are affected by AR, low flow, etc.?

Answer 9

Peak Velocity

Mean gradient

Question 10

Severe AVP obstruction: Mean gradient, DI, EOA

Answer 10

>35

<0.25

<0.8

Question 11

EOA for Normal and severe AVP obstruction

Answer 11

Normal EOA > 1.2 cm^2

Severe AVPS

Question 12

can a dysfunctional AVP have a normal peak velocity and mean gradient?

Answer 12

yes

Question 13

In evaluating AVP if you get a peak velocity > 3m/s (high), but normal DI (or DVI) and normal AT, what can the diagnosis be (x2)? What to use to diagnose these?

Answer 13

High Flow or PPM (iEOA)

Question 14

what can aacount for different calculaitons of pressure/velovity across a prosthetic AV in cath lab vs. echo?

Answer 14

pressure recovery location used

Question 15

what is Aortiv Valve PPM determined by? what is normal and what is severe?

Answer 15

iEOA

No AV PPM if > 0.85

Severe AV PPM if < 0.65

(cut offs different for MV)

Question 16

name 3 things causing higher mortality with PPM

Answer 16

<70 y/o

BMI < 30

Low EF

Question 17

in AVP, what does iEOA > 0.85 indicate?

Answer 17

High Flow

Question 18

when measuring PW to calculate EOA of TAVR prosthesis, where do you place sample volume and why?

Answer 18

• outside cage
• if PW placed within stent/proximal to cusps to measure LVOT velocity, EOA is OVERESTIMATED. B/c flow acceleration happens twice for TAVR prostheses)

Question 19

for AVP, if MG is less than expected (>35 is severe AVPS), what do you do?

Answer 19

use multiple windows to get CW doppler

Question 20

for AVP: MG>35 , DI< 0.25, AT >100ms, rounded jet =?

Answer 20

Pathologic stenosis

Question 21

for AVP: MG> 35, DVI (DI) > 0.25, AT <100ms, triangular jet = ? ; how do you differentiate the types?

Answer 21

Functional Stenosis

iEOA < 0.65 = PPM

iEOA > 0.85 = Pressure Recovery

Question 22

do you use CW or PW for E velocity?

Answer 22

CW

Question 23

MVP TVI ratio

Answer 23

TVI mvp/TVI lvot

(inverse for AVP)

Question 24

PHT> ? E >? indicates severe MVP obstruction?

Answer 24

PHT > 130ms

E > 1.9m/s

Question 25

why can you NOT use 220/PHT to calculate EOA of MV Prosthesis?

Answer 25

overestimates EOA

Question 26

do you use continuity eq’n or 220/PHT to calculate Prosthetic MVA?

Answer 26

continuity eq’n (cant use if severe AR or MR)

Question 27

Normal values and Severe MVP stenosis for Peak Velocity? MG? TVI Ratio?

Answer 27

Peak Velocity: <1.9 or > 2.5

MG < 5 or >10

TVI Ratio: <2.2 or > 2.5

Question 28

for Prosthetic MV, what is normal iEOA, what is severe stenosis?

Answer 28

Normal iEOA > 1.2

MVPS, iEOA < 0.9

Question 29

Prosthetic MV w/ MG> 10, but PHT<130 and TVI Ratio > 2.2, iEOA > 1.2. Diagnosis?

Answer 29

regurgitation

Question 30

Prosthetic MV MG> 10, but PHT < 130 and:

TVI Ratio <2.2

iEOA > 1.2

DIagnosis?

Answer 30

High output

Question 31

Prosthetic MV MG> 10, but PHT < 130 and:

TVI Ratio < 2.2

iEOA < 1.2

Diagnosis?

Answer 31

PPM

Question 32

Best initial test (AUC criteria) for prostehtic valve endocarditis?

Answer 32

TTE (can jump straight to TEE if mod-high pre-test probability)