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Cardiac > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

Inlet valves

A

Mitral and tricuspid

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2
Q

Outlet valves

A

Aortic and pulmonary

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3
Q

Valves are defined by their

A

Downstream chamber or vessel

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4
Q

Primary function of cardiac valves

A

Provide minimal resistance to forward flow, while preventing backward regurgitant flow

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5
Q

Mitral valve apparatus is comprised of the

A

Valve leaflets (anterior and posterior), chordae tendinae and papillary muscles

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6
Q

The 2 mitral valve leaflets are each divided into how many scallops and clefts

A

3 scallops separated by 2 clefts

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7
Q

Largest scallop of mitral valve

A

Middle

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8
Q

Continuous fibrous ring that surrounds the mitral valve leaflets

A

Mitral annulus

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9
Q

Supplies the anterolateral papillary muscles

A

Left anterior descending coronary artery or the left circumflex coronary artery

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10
Q

Posteromedial papillary muscle is generally supplied by the

A

Right coronary artery

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11
Q

3 leaflets of tricuspid valve:

A

Anterior, posterior and septal leaflets

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12
Q

3 papillary muscles of tricuspid valve

A

Anterior, posterior and septal

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13
Q

The anterior papillary muscle of tricuspid valve can attach to

A

Anterior leaflet alone or to both anterior and septal leaflets

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14
Q

Posterior papillary muscle of tricuspid valve can attach to the

A

Posterior and septal leaflets

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15
Q

Septal papillary muscle of tricuspid valve cqn attach to

A

Septal and anterior leaflets

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16
Q

aortic and pulmonary valves are named according to

A

sinus of Valsalva from which coronary arteries typically arise

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17
Q

the noncoronary cusp is typically located where

A

posterior

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18
Q

left and right cusps of aortic and pulmonary valves usually abut or face the

A

pulmonary valve, referred to as the “facing” sinuses of Valsalva

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19
Q

aortic and pulmonary valves opens during

A

ventricular systole

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20
Q

aortic and pulmonary valves closes at the

A

end of ventricular systole, as the pressure in the RV drops

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21
Q

can be seen as “O” or “C”-shaped dense structure at the expected location of the mitral annulus

A

mitral annular calcification

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22
Q

chronic degeneration of the fibrous ring of the mitral valve and may be seen in younger patients with renal disease or abnormal calcium metabolism

A

mitral annular calcification

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23
Q

these valves are not well evaluated in echocardiography due to their position

A

pulmonary and tricuspid valves

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24
Q

clinical gold strandard for noninvasive measurement of blood flow and is routinely used to quantify the severity of valvular stenosis or regurgitation

A

phase contrast MRI

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25
Q

measurements of blood flow in phase contrast MRI are typically performed where

A

perpendicular to the direction of blood flow, centered in the vessel or valve of interest

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26
Q

for valuvular stenosis, peak velocities are measured where

A

near or just distal to the location of severe stenosis

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27
Q

for valvular regurgiation, two approaches are commonly used in phase contrast MRI

A

measuring the amount of regurgital flow below a zero baseline near the valve or vessel of interest, directly measuring the regurgitant jet during the systolic portions of the cardiac cycle where regurgitation is observed

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28
Q

two primary metrics in valvular regurgitation

A

RVol and RF

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29
Q

defined as the amount of blood flow backward through the valve and is typically defined in units of either liters per minute or milliliters per beat

A

RVol

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30
Q

defined as RVol divided by the forward flow volume

A

RF

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31
Q

Most common CHD, in which two of the leaflets of the aortic valve may be partly or completely fused, resulting in a two-cusped valve rather than the normal three cusped valve

A

Bicuspid aortic valve

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32
Q

Bicuspid aprtic valve is associated with

A

Aortopathy, aneurysm, aortic dissection and rupture, aortic coarctation; with approximately half demonstrates dilatation of the aortic root and proximal ascending aorta

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33
Q

most common type of subaortic stenosis, typically resulting in murmur

A

subaortic membrane

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34
Q

acquired aortic valve disease is often caused by

A

degenerative calcification and chronic leaflet deterioration

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35
Q

most common valve disease, generally occurring among older patients

A

aortic stenosis

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36
Q

aortic valve area is determined by ______, which states that the blood flow passing through a tube must be equal, measured at any location along that tube, in order to satisfy conservation of mass

A

continuity equation

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37
Q

AVAs below ____ cm2 are considered moderate

A

1.5 cm2

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38
Q

AVAs below __ cm2 are considered severe

A

1 cm2

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39
Q

AVAs less than ___ cm2 are considered critical

A

0.5 cm

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40
Q

severe aortic valve stenosis typically correlates with peak aortic velocities over __ m/s mean gradients exceeding ___ mmHg

A

4 m/s; 40 mmHg

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41
Q

management for severe aortic stenosis

A

surgical aortic valve replacement or transcatheter aortic valve replacement (TAVR)

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42
Q

preprocedure planning for TAVR is now routinely performed with cardiac ct, for measurement of

A

size of the aortic annulus, evaluation of vascular access, and prediction of projection angles for prosthesis deployment

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43
Q

aortic annulus is typically measured in

A

systole in a double oblique plane immediately below the hinge points of the aortic valve cusps

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44
Q

presents as initially increased total left ventricular stroke volume through compensatory mechanisms, resulting in dilation and concentric left ventricular hypertrophy

A

aortic regurgitation

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45
Q

aortic regurgitation is measured qualitatively by _____, but when needed for clinical management, RVol and RF can be quantified through ______

A

quali- echocardiography, quanti- MRI

46
Q

defined as bowing or prolapse of the mitral leaflet of 2 mm or beyond the annular plane into the LA in ventricular systole

A

mitral valve prolapse

47
Q

most common cause of sever nonischemic mitral regurgitation

A

MVP

48
Q

MVP is caused by

A

rupture or elongation of the chordae tendinae

49
Q

most commonly involved mitral leaflet in MVP

A

middle scallop of the posterior leaflet (P2 segment)

50
Q

prolapsed mitral valve scallop is classified as a _____ (with bowing of the leaflet body) or _____ (with free leaflet edge prolapse)

A

billowing leaflet and flail leaflet

51
Q

conditions that are associated with secondary MVP include

A

connective tissue disorders (such as Marfan) and CHD (ostium secundum ASD and aortic coarctation)

52
Q

characterized by division of one of the mitral leaflets

A

mitral cleft

53
Q

typically involved leaflet in mitral cleft

A

anterior

54
Q

cleft mitral valve is associated with

A

progressive mitral regurgitation

55
Q

in this condition, the mitral cleft is oriented toward the LVOT rather than the inlet septum, as is the case of patients with endocardial cushion defect (AVSD)

A

isolated mitral cleft

56
Q

this condition can occur congenitally with hypoplasia of the mitral valve annulus, fusion of the mitral valve commissure and shortened or thickened chordae tendineae

A

mitral stenosis

57
Q

mitral stenosis can be seen in association with

A

multiple left-sided cardiac anomalies in what is known as Shone complex, including parachute mitral valve or supramitral ring

58
Q

mitral stenosis is often congenital or acquired

A

acquired (most commonly due to RHD)

59
Q

MS characteristically results in ______ as a compensatory mechanism in order to maintain normal cardiac output

A

increased LA pressure

60
Q

increased LA pressure in this condition presents with LA enlargement and increased pulmonary venous pressure, eventually leading to pulmonary hypertension

A

MS

61
Q

noninvasive clinical standard for assessing severity of MS

A

transmitral gradient, measured by Doppler echocardiography, combined with mitral valve planimetry and pressure half-time

62
Q

MR caused by changes of left ventricular structure and function related to ischemia

A

ischemic MR

63
Q

caused by rupture of a mitral papillary muscle occurring during the acute phase of myocardial infarction, and is associated with high mortality

A

acute ischemic MR

64
Q

occurs more than 2 weeks after infarction with absence of structural mitral valve disease, and is caused by modifications of geometry and kinetics of the subvalvular apparatus, resulting from abnormalities of regional myocardial contraction

A

chronic ischemic MR

65
Q

can also occur secondarily as a result of LV failure

A

MR

66
Q

management of primary MR

A

surgical repair

67
Q

most common cause of congenital TR

A

Ebstein anomaly

68
Q

characterized by variable and abnormal developmental anomaly of tricuspid valve including apical displacement of the septal and posterior tricuspid valve leaflets, redundancy and fenestration of the anterior tricuspid leaflet and dilation of the true tricuspid annulus

A

Ebstein anomaly

69
Q

chambers that dilate in ebstein anomaly

A

RA and RV, with TR

70
Q

pulmonary vascularity in ebstein anomaly

A

either normal or decreased

71
Q

cut off of apical displacement of the septal leaflet for Ebstein anomaly

A

> 8mm/m2

72
Q

cyanotic type of CHD characterized by agenesis of the tricuspid valve

A

tricuspid atresia

73
Q

necessary for survival in TA

A

obligatory intra-atrial connection through an ASD or patent foramen ovale

74
Q

in TA, RV is typically ___, while RA is

A

RV is small and hypoplastic, RA is dilated and hypertrophied

75
Q

TA is associated with

A

right-sided aortic arch and TGA

76
Q

patients with TA without TGA typically have

A

some degree of PS

77
Q

pulmonary vascularity in TA

A

decreased pulmonary vascularity and flat or concave MPA

78
Q

depicts fatty or muscular separation of the RA from RV in cardiac CT and MRI

A

TA

79
Q

rare and is most often congenital or acquired due to RHD. it presents with increased pressure gradient between the RA and RV (?5 mmHg), resulting in venous congestion.

A

TS

80
Q

RA in TS appears

A

enlarged

81
Q

refers to dynamic or fixed anatomic obstruction to blood flow from the RV to the pulmonary arterial vasculature

A

congenital PS

82
Q

levels of obstruction in PS

A

valvular, subvalvular or supravalvular

83
Q

the pulmonic valve commissures may be partially fused resulting in a narrow central orifice, often leading to postenotic dilation of the MPA

A

PS

84
Q

In PS, valve leaflets may also be irregular and thickened without commissural fusion, as is the case in the majority of patients with what syndrome

A

Noonan syndrome

85
Q

occurs due to narrowing of the infundibular or subinfundibular right ventricular outflow tract and is present in individuals with TOF

A

subvalvular PS

86
Q

rare condition resulting from fibromuscular narrowing of the RVOT with subvalvular RVOT obstruction

A

Double-chambered RV

87
Q

can result from pulmonic valve obstruction at the level of MPA, at its bifurcation, or more distal branches

A

supravalvular PS

88
Q

approximately 20% of patients with TOF have associated what type of PS

A

supravalvular PS

89
Q

PR can develop from

A

congenital PS or TOF that underwent pulmonary valvuloplasty or surgical repair during infancy of early childhood

90
Q

patients with severe PR may eventually dilate what chamber

A

RV, develop RV failure

91
Q

MRI is commonly used to measure both severity of PR and measure the severity of dilation of the RV to determine the need for surgical or interventional valve replacement rather than 2d echo due to

A

pulmonary valve is not readily visualized in 2d echo due to its position behind the sternum

92
Q

refers to an infection of the valve leaflets as well as prosthetic valves

A

infective endocarditis

93
Q

often appears as an irregular mobile or fixed mass attached to the low-pressure side of a valve due to infection

A

vegetation formation from infective endocarditis

94
Q

useful in diagnosing IE, assessing severity of disease and following patients undergoing treatment

A

Echocardiography

95
Q

useful in identifying and characterizing vegetations, valve destruction and perivalvular extension

A

cardiac CT and MRI

96
Q

often superior in detecting small vegetations and valve perforations

A

TEE

97
Q

common heart-related manifestation in patients with SLE. Unlike IE, these lesions rarely result in hemodynamically significant valve dysfunction and rarely embolize

A

Libman-Sacks nonbacterial endocarditis

98
Q

in Libman-Sacks nonbacterial endocarditis, small valve vegetations typically affect the ventricular and atrial sides of m

A

the ventricular and atrial sides of mitral valve

99
Q

refers to valve fibrosis and scarring caused by an autoimmune reaction to infection with group A streptococci, resulting in valve stenosis and/or regurgitation

A

rheumatic valve disease

100
Q

most common involved valve in RHD is

A

mitral valve, followed by aortic, tricuspid and pulmonic valves

101
Q

true or false: in most cases of RHD, mitral valve is involved along with one or more other valves

A

true

102
Q

in RHD, chronic elevation of LA pressure needed to move blood across the stenotic mitral valve results in

A

atrial dilation and elevated pulmonary pressure

103
Q

approximately 30 to 40% of symptomatic patients with MS develop

A

atrial fibrillation

104
Q

frequent occurrence in patients with carcinoid syndrome. approximately 30 to 40% of patients with neuroendocrine tumors (most commonly midgut carcinoids) present with carcinoid syndrome, including episodes of flushing, hypotensionm diarrhea and bronchospasm

A

carcinoid heart disease

105
Q

important contributing factor in the development of carcinoid heart disease

A

chronic exposure to excessive circulating serotonin

106
Q

characterized by development of plaque-like, fibrous endocardial thickening involving the heart valves

A

carcinoid heart disease

107
Q

commonly involved valves in carcinoid heart disease

A

tricuspid and pulmonic

108
Q

first imaging modality in carcinoid heart disease

A

TTE

109
Q

imaging features include thickening of valve leaflets/cusps and subvalvular apparatus, retraction and altered motion of the leaflets/cusps and valve regurgitation (ranging from mild to severe)

A

carcinoid heart disease

110
Q

postoperative complications following valve surgery include

A

infection, dehiscence and perivalvular leak

111
Q

late complications of valve surgery include

A

valve regurgitation, IE anastomotic dehiscence, pseudoaneurysm and thromboembolic events

Cardiac (8 decks)

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