Valve Disease Flashcards

1
Q

Parameters of severe MR

A
vena contracta > /= 0.7
RVol >/= 60mL
RF >/= 50%
ERO >/= 0.4cm^2
LV dilation (LV ESD > 40mm)
for a central jet, jet area >/= 50% of LA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A truncated, triangular, early peaking MR CW doppler jet contour signifies what

A

high LA pressures, as can be seen in acute severe MR

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

What’s the formula for MR Regurgitant Volume calculation using doppler method

A

RegV = (0.785 x MA diameter^2 x MA VTI) – (0.785 x LVOT diameter^2 x LVOT VTI)

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

What’s the equation for MR Regurgitant Fraction

A

RF = (RegV / MA vol) x 100

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

What’s the formula to calculate MR Regurgitant volume using combined 2D-doppler method?

A

RegV = total LV SV (biplane method) – LVOT SV

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

What’s the equation for EROA?

A

EROA = Regurgitant Volume / VTI of MR jet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the definition, valve anatomy, valve hemodynamics (MVA, PG, velocities), hemodynamic consequences and symptoms for Stage A mitral stenosis

A

Stage A: at risk for mitral stenosis, mild valve doming in diastole, normal transmitral flow velocity, no pulmonary HTN or LAE, no symptoms

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

List the definition, valve anatomy, valve hemodynamics (MVA, PG, velocities), hemodynamic consequences and symptoms for Stage B mitral stenosis

A

Stage B: progressive mitral stenosis, commissural valve fusion and diastolic doming of leaflets, increased transmitral flow velocities but with MVA >/= 1.5cm2 and PHT < 150ms, normal resting RVSP, mild to moderate LAE, no symptoms

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

List the definition, valve anatomy, valve hemodynamics (MVA, PG, velocities), hemodynamic consequences and symptoms for Stage C and D mitral stenosis

A

Stage C: severe asymptomatic, commissural fusion and diastolic doming, MVA = 1.5cm2, PHT >/= 150ms, severe LAE, RVSP > 30, no symptoms
Stage D is severe symptomatic and has all the same features except with symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the MVA and PHT seen in very severe MS?

A

MVA = 1, PHT >/= 220 (remember that MVA=220/PHT thus a MVA of 1 will give a PHT of 220)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What indicates absent flow reserve in DSE for LFLG aortic stenosis? What does minimal reserve by DSE signify?

A

Change in LVOT VTI <20% with dobutamine; signifying that the DSE cannot distinguish between pseudo severe and severe AS

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

What is the equations for mitral valve area using PHT and DT?

A

MVA= 220/PHT and MVA= 759/DT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the max velocity and pressure gradient cutoffs for mild, moderate and severe PS?

A

mild: max velocity < 3m/s, PG < 36mmHg
mod: max velocity 3-4m/s, PG 36-64mmHg
sev: max velocity >4m/s, PG > 64mmHg

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

What is the threshold for normal stroke volume index?

A

> 35mL/m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

For asymptomatic severe AR, what LV parameters and values should prompt AVR?

A

LVEF < 50% (Class I recommendation)
LVESD > 5 with EF > 50% (Class IIa)
LVEDV > 6.5 with EF > 50% (Class IIb)

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

What change do you expect to see after a PVC for AS vs HOCM on intracardiac pressure waveforms?

A

Post PVC there is increased contractility due to higher calcium accumulation and decreased afterload due to depletion/runoff of Ao volume; leads to higher pulse pressure (higher Ao systolic pressure) for AS and lower pulse pressure for HOCM (Brockenborough/Braunwald sign) with “spike and dome” waveform

17
Q

What is the Aortic Regurgitation Index (after TAVR)? How is it used?

A

[(DBP-LVEDP)/SBP] x 100

Less than or equal to 25% suggests at least moderate PVL which would need intervention (like additional balloon angioplasty)

18
Q

What happens to carotid upstroke and murmur for HOCM after a PVC?

A

Carotid upstroke is diminished and murmur is louder after PVC due to increased contractility and decreased afterload.

19
Q

What is the threshold for contractile reserve in DSE for AS? What does it tell you about the patient/prognosis?

A

> /= 20% increase in stroke volume with dobutamine

Patients with contractile reserve do better with SAVR; patients with no contractile reserve have higher perioperative mortality but should still undergo AVR as long term EF tends to improve and symptoms/mortality goes down (consider TAVR because that increased perioperative mortality is not there with TAVR)

20
Q

What’s a normal LVOT VTI?

21
Q

What is the equation for dimensionless index?

A

DI = LVOT peak velocity / AoV peak velocity

22
Q

In aortic stenosis, what is the peak to peak gradient?

A

the pressure difference between peak LV systolic pressure and peak aortic systolic blood pressure

23
Q

What’s a trick for determining mean gradient across AoV if all you have is peak velocities?

A

mean PG is roughly 60% of peak PG

24
Q

For mitral valve, what is considered rapid E wave deceleration time?

25
what does the mitral inflow CW profile look like for cor triatriatum?
continuous anterograde flow in both systole and diastole resulting in 3 distinct anterograde envelopes (systolic, E wave and A wave)
26
when calculating orifice area by PISA, which of the two Nyquist limits should you use?
use the Nyquist limit that is in the same direction as the flow through the orifice
27
when calculating Ao valve mean PG, when does the proximal (LVOT) velocity need to be included in the simplified Bernoulli equation?
when V1 is > 1m/s or V2 is < 3m/s both velocities must be used: maximum PG= 4(V2^2 - V1^2)
28
what's the equation for projected Ao valve area with normal flow rate?
projected AVA= AVA rest + [(AVApeak- AVA rest)/(Qpeak - Qrest)] x (250mL/s - Q rest) note that Q= stroke volume/ ejection time
29
list the criteria that define severe AI
1. EROA >/= 0.3cm^2 2. Regurgitant fraction >/= 50% 3. Regurgitant volume >/= 60mL/beat 4. vena contracta > 0.6cm 5. ratio of regurgitant jet width to LVOT diameter >/= 65% 6. holodiastolic flow reversal in descending aorta
30
When should pulmonic stenosis be intervened upon?
Symptomatic with mean PG >/=30 | Asymptomatic with mean PG >/=40
31
what is the indexed effective orifice area cutoff for aortic valve patient-prosthetic mismatch?
indexed EOA = 0.85cm^2/m^2 | severe PPM is = 0.65cm^2/m^2
32
what is the indexed effective orifice area cutoff for mitral valve patient-prosthetic mismatch?
indexed EOA = 1.2cm^2/m^2