Valvular

Question 1

Supravalvular aortic stenosis location

Answer 1

Obstruction at aorta

Single discrete narrowing or long tubular hypoplasia

Question 2

Supravalvular AS exam

Answer 2

Loud A2

Thrill in SSN or R carotid

Question 3

Echo supravalvular AS

Answer 3

High velocity jet with narrowed aorta

Question 4

Subvalvular AS anatomy

Answer 4

Discrete ridge or tunnel stenosis

Question 5

Diagnosis of subvalvular AS

Answer 5

High doppler gradient and normal AV

Question 6

Treatment for subvalvular AS

Answer 6

Operate for most patients

Question 7

Cut-off for aorta surgery with BAV

Answer 7

5. 5 cm
6. 0 cm if FH, rapid growth, low risk
7. 5 cm if AVR indicated

Question 8

AS severe by exam / symptoms but not MG

Answer 8

Do hemodynamic Cath or further evaluation

Question 9

Indications for severe AS surgery

Answer 9

Symptoms
EF < 50% with LVH
Very severe AS and surgical risk < 1%

Question 10

Very severe AS criteria

Answer 10

Vel >= 5

MG >= 60

Question 11

Severe MS S2-OS interval

Answer 11

<70

Question 12

Severe MS MVA

Answer 12

<= 1.5

Question 13

Very severe MS MVA

Answer 13

< 1.0

Question 14

MS symptoms out of proportion to MG ->

Answer 14

Exercise hemodynamics

Question 15

Indication for intervention pliable rheumatic MS

Answer 15

Class II-IV symptoms for PMBV

Can consider also is asx, PAP > 60, new-onset AF

Question 16

Indication for intervention MAC MS

Answer 16

Class III-IV symptoms -> MVR

Question 17

Acute MR treatment

Answer 17

Vasodilators
IABP
Surgery

Question 18

Severe MR jet area

Answer 18

> 1/2 LA

Question 19

Severe MR RV

Answer 19

> 60

Question 20

Severe MR RF

Answer 20

> 50%

Question 21

Severe MR ERO

Answer 21

> 0.4

Question 22

Indications for surgery for severe chronic MR

Answer 22

Symptoms
EF < 60
ESD > 40
Prophylactic repair without symptoms (low operative mortality, high chance of successful repair)

Question 23

Acute AR treatment

Answer 23

Urgent surgery for dissection or acute prosthetic AR
No IABP
Nitroprusside / inotropes
No pressers or beta blockers

Question 24

Severe AR jet

Answer 24

> 60% LVOT diameter

Question 25

Severe AR descending thoracic aorta

Answer 25

Holodiastolic flow reversal | Velocity > 0.2 m/s

Question 26

Severe AR RV

Answer 26

>60

Question 27

Severe AR RF

Answer 27

>55%

Question 28

Severe AR indications for surgery

Answer 28

Symptoms EF < 50% or abnormal ESD > 50, EDD > 65

Question 29

Severe TR echo features

Answer 29

Dagger shaped TR velocity, low velocity, dense signal | Systolic reversal hepatic veins

Question 30

Treatment left sided mechanical valve thrombosis class III/IV symptoms

Answer 30

Surgery or fibrinolysis

Question 31

Treatment left sided mechanical valve thrombosis class I/II symptoms

Answer 31

Large clot - surgery, lysis (0.8-1.0) | Small clot - lysis or UFH

Question 32

Treatment right sided mechanical valve thrombosis class III/IV symptoms

Answer 32

Lysis

Question 33

Treatment right sided mechanical valve thrombosis class I/II symptoms

Answer 33

Large clot - lysis | Small clot - UFH

Question 34

Bioprosthetic valve thrombosis treatment class I-III

Answer 34

30 days of VKA then repeat imaging

Question 35

Bioprosthetic valve thrombosis treatment class IV

Answer 35

Valve replacement or lysis

Question 36

Infective endocarditis prophylaxis groups

Answer 36

Prosthetic valves / material for valve repair Prior IE Transplant with valvulopathy CHD and unprepared cyanotic lesions, cyanotic lesions with palliative shunts or conduits, repair <= 6 months with prosthetic material, repaired lesion with residual defects

Question 37

Procedures that require IE ppx

Answer 37

Dental procedures Incision into active skin / STI Incision or biopsy in respiratory tract

Question 38

Drugs for IE ppx

Answer 38

30-60 min before procedure Amoxicillan 2 g PO Clindamycin 600 mg PO, IM or IV

Question 39

Major Duke Criteria

Answer 39

Multiple Bcx+ Single coxiella burnetti+ Endocardial involvement - new regurgitation, vegetation, abscess, dehiscence

Question 40

Minor Duke Criteria

Answer 40

``` Clinical predisposition Fever without alternative BCx or serologic evidence of infection not meeting major criteria Vascular phenomena Immunologic phenomena ```

Question 41

Definite IE Duke criteira

Answer 41

2 major 1 major + 3 minor 5 minor

Question 42

Possible IE Duke criteria

Answer 42

1 major + 1 minor | 3 minor

Question 43

Surgical indication for IE

Answer 43

Valve dysfunction with HF Left sided S. aureus or fungal organisms Heart block, abscess, destructive lesions Persistent bacteremia or fevers >= 5 days Recurrent emboli of persistent vegetation despite abs Mobile veg >= 10 mm Other surgical indications

Question 44

AV prosthesis stenosis

Answer 44

Elevated transvalvular velocity / gradient AT > 100 ms EOA < 1 DI < 0.3