Prosthetic valves and VADs Flashcards

1
Q

Echo assessment of prosthetic valves

A

2d- type of valve, well seated, leaflets moving, any masses
color doppler- antegrade flow, washing jets, pathologic regurg, paravalvular leak
hemodynamics - velocity, gradients, area calculation
look for colateral damage

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2
Q

anatomic vs antianatomic mitral mechanical valve

A

anatomic- leaflets in same orientation as native valve
anti-antatomic- leaflets perpendicular (favors symmetric blood flow)

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3
Q

Will protamine fix paravalvular leaks

A

small low velocity leaks typically resolve

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4
Q

DVI for prosthetic aortic valve

A

normally .35-.5

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5
Q

medtronic hall tilting disc regurgitant jet

A

large central, small peripheral

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6
Q

st jude washing jets

A

directed inward

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7
Q

on x washing jets

A

directed away (divergent)

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8
Q

Differential for high gradient after replacement

A

bad measurement - over tracing, MR contamination
bad math
bad physics
bad choices
bad valve

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9
Q

Situations where pressure recovery becomes an issue

A

Things that favor laminar flow
small ascending aorta <3cm
Bentall
Mechanical AV

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10
Q

Indexed EOA for patient prosthesis mismatch

A

<0.85 cm2/m2

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11
Q

increased suspicion for valve obstruction

A

low lvot velocity
dvi <0.25
calculated eoa<predicted>100 ms</predicted>

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12
Q

VADS exam prebypass

A

AV function (stenosis, insufficiency)
Shunts (interatrial septal defects)
Intracardiac thrombus
Right ventricular function - RVEF , TR >mod?
Mitral valve function - (stenosis)
aortic atherosclerosis for outflow

STAR

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13
Q

Weaning VADS from bypass

A

evaluate lvad inflow cannula - avoid suckdown, vpeak <2 m/s
adequate flow - appropriate LV vol
AV function- no AI
shunts-interatrial septal defects
De-airing
RV function

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14
Q

VAD post bypass exam

A

RV function-usually the biggest problem
Unobstructed inflow cannula- vpeak <200m/s
volume status
intact septum

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15
Q

post op vads

A

hypoxia- look for pfo
cva- look for pfo or thrombus
HD instability - hypovolemia (bleeding) , tamponade, RV failure, infection, device failure

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16
Q

Indications for IABP

A

LV systolic failure
post bypass HD collapse
unstable angina
preop for high risk pts (LM disease, critical AS)

17
Q

contraindications to IABP

A

significant AI
significant aortic disease
aortic dissection
prosthetic graft in descending aorta
aorto-pulmonary shunt (BT shunt)

18
Q

complications of IABP

A

ao dissection, arterial perf
limb ischemia
thrombocytopenia
thromboembolic complications
balloon rupture w helium embolus
hematoma
psuedoaneurysm
infection
bleeding

19
Q

peak velocity cutoff for possible stenosis in prosthetic mitral valve

A

1.9-2.5 m/s

20
Q

mean gradient for possible stenosis in prosthetic mitral valve

A

6-10 mmHg

21
Q

DVI for possible prosthetic mitral stenosis

A

2.2-2.5

22
Q

EOA for possible prosthetic mitral stenosis

A

1-2

23
Q

PHT for possible prosthetic mitral stenosis

A

130-200 msec

24
Q

What LVAD power and speed likely indicates thrombosis with obstruction

A

power greater than 10 watts and pump speed remains around 900 rpm (power spike)

25
Q

lvad low flow alarm differential

A

suction event
hypovolemia
rv failure
tamponade
malignant hypertension
inflow or outflow obstruction
arrhythmia

26
Q

lvad high flow alarm differentail

A

sepsis or medication vasodilation
rotor/bearing thrombosis with pump malfunction
significant AI

27
Q

North south syndrome

A

occurs with VA ecmo as heart starts to eject and recover before the lungs recover. Ejects deoxygenated blood and ecmo ejects oxyenated blood

28
Q

Calculating PAPI and TPG

A

PAPI= PASP-PADP/ RAP
TPG=MPAP-PCWP