Valves

Question 1

Criteria for severe AS?

Answer 1

AV max velocity > 4 m/s
AVA < 1 cm2
DI < 0.25
Mean PG > 50
Max PG > 70

Question 2

What is Gorlin equation?

Answer 2

Peak gradient = CO/AVA, therefore AVA = CO/PG

Question 3

DDx for high AV velocities?

Answer 3

LVOT obstruction
Subvalvular obstruction (subaortic membrane, muscular subaortic stenosis)
Supravalvular obstruction

Question 4

What distinguishes AS doppler profile from MR?

Answer 4

AS occurs BETWEEN IVCT and IVRT whereas MR occurs during these two intervals.

Question 5

Criteria for severe AI?

Answer 5

JetA:LVOTA > 60%
JetD:LVOTD > 65%
PHT < 200 ms
Desc aortic systolic flow reversal
Vena contract > 0.6 cm
EROA > 0.3 cm2
RVol > 60 mL

Question 6

AI features predictive of surgery?

Answer 6

Severe features
Sinus of valsalva diameter > 5 cm
LV dilatation
EF < 50%

Question 7

AI jet can be used to calculate what pressure?

Answer 7

LVEDP = DBP - (AR end diastolic velocity)^2

Question 8

Features of severe MS?

Answer 8

MVA < 1 cm2
PHT > 200 ms
Mean gradient > 10 mmHg

Question 9

Three ways to calculate MVA in setting of MS?

Answer 9

MVA = (LVOT VTI)(LVOT Area)/(MV VTI)
MVA = 759/DT
MVA = 220/PHT

Question 10

Criteria for severe MR?

Answer 10

JetA:LVOTA > 40 %
Jet area > 10 cm2
Pulm vv flow reversal
Vena contracta > 7 mm
PISA radius > 10 mm
RVol > 60 mL
Dense MR envelope with "V-wave cut off sign)

Question 11

Criteria for severe TR?

Answer 11

Jet A > 10 cm2
Vena contract > 7 cm
Dense CWD jet
Hepatic vv S wave reversal

Question 12

Criteria for severe TS?

Answer 12

mPG > 5 mmHg

TS is rare. Rheumatic most common. Also congenital & carcinoid.

Question 13

Criteria for severe PI?

Answer 13

RV dilatation
Large jet > 50% RVOT diameter
Dense envelope
Steep envelope deceleration
PH < 100 ms
Main PA diastolic flow reversal

Question 14

Criteria for severe PS?

Answer 14

Peak gradient > 64 mmHg
mPG > 40 mmHg
peak velocity > 4 m/s

Look for RV dilatation, proximal PA dilatation, thickened leaflets, and flow acceleration.

Question 15

Four types of prosthetic valves and additional subtypes

Answer 15

Bioprosthetic, mechanical, homograft, composite

Mechanical: ball in cage, tilting disc, bileaflet

Bioprosthetic: stented, non-stented, and transcutaneous

Question 16

Equation for EOA?

Answer 16

EOA = SV / VTI

Question 17

What is pressure recovery?

Answer 17

Proximal AoV w/ high pressure & low velocity, distal to AoV low pressure & high velocity → CWD overestimation of pressure gradient and thus severity

Question 18

Criteria for severe PrAoV obstruction?

Answer 18

Peak velocity > 4 m/s
mPG > 35
DVI < 0.25
AT > 100 ms
EOAi < 0.8 cm2

Question 19

Criteria for severe PrMV obstruction?

Answer 19

Peak velocity > 2.5 m/s
PHT > 200
mPG > 10
EOAi < 1 cm2
VTI MR/VTI LVOT > 2.5

Question 20

Criteria for patient prosthesis mismatch?

Answer 20

High gradient
Normal DVI and AT
EOAi < 0.8 cm2
Severe = EOAi < 0.65 cm2

Question 21

Calculation for valve area in TS and MS

Answer 21

MVA = 220/PHT, OR 759/DT

TVA = 190/PHT