Valvular Heart Disease

Question 1

What valvular pathologies are common in patients with congenital heart disease?

Answer 1

PS, AS

Question 2

What valvular pathologies are common in patients with indigenous patients?

Answer 2

rheumatic MS

Question 3

What valvular pathologies are common in elderly patients ?

Answer 3

degenerative AS, MR, TR

Question 4

What is the most common valvular lesion?

Answer 4

Aortic Stenosis

Question 5

What is the murmur of aortic stenosis?

Answer 5

ejection systolic, crescendo decrescendo

Question 6

What are markers of severity for AS on echo?

Answer 6

• AS jet velocity- cut off 4.0 m/s
• Mean gradient- cut off 40mmHg
• Continuity equation valve area – cut off 1.0 cm2

Question 7

What is the management of AS?

Answer 7

no medical therapy.
symptomatic –> low surgical risk –> surgery, otherwise surgery to TAVR

Question 8

What is the murmur of aortic regurgitation?

Answer 8

3 murmurs
(1) early diastolic decrescendo murmur loudest in left sternal edge
(2) concomitant systolic flow murmur (can have concomitant aortic stenosis), (3) austin flint murmur (low pitched mid-diastolic rumble, occurs when AR jet impinges AMVL)

Question 9

What can cause acute severe AR?

Answer 9

aortic dissection and endocarditis

Question 10

True or false. Intra-aortic balloon pump is contraindicated in acute severe AR

Answer 10

True

Question 11

What is the murmur of mitral regurgitation?

Answer 11

high pitched holo-systolic murmur

Question 12

What is the murmur of mitral stenosis?

Answer 12

low pitched diastolic rumble

Question 13

How do you assess mitral stenosis severity on echo?

Answer 13

Severe is valve area <1.0, mild is >1.5cm.
mean gradient >10
pulmonary artery HTN >50

Question 14

What is Bernoulli equation?

Answer 14

Change in pressure across an orifice is proportional to the square of the velocity of the fluid flowing through the orifice.

change in pressure: 4V^2

Question 15

How to calculate RV systolic pressure

Answer 15

4(TR velocity)^2 + right atrial pressure

Question 16

What is the management of AR?

Answer 16

Severe AR
- Symptomatic –> AVR
- Asymptomatic
o LVEF <55% –> AVR (1)
o Other cardiac surgery –> AVR (1)
o LVEF >55% and LVESD >50mm –> AVR (2a)
o Progressive decrease in LVEF to <55%-60% or increased in LVEDD to >65 on at least 3 studies –> low surgical risk –> AVR (2b)

Moderate AR
- Other cardiac surgery –> AVR (2a)

Question 17

What is the management for mitral stenosis?

Answer 17

Severe MS
- Symptomatic –> pliable valve, no clot, <2+ MR –> percutaneous mitral balloon commissurotomy
- Severe symptoms –> surgery vs PMBC
- Asymptomatic –> pliable valve, no clot, <2 + MR, PA systolic pressure >50 or AF –> PMBC at CVC

Progressive MS MVA >1.5cm –> exertional symptoms –> stress test –> if haemodynamically significant MS –> Pliable valve, no clot, <2 + MR –> PMBC

Question 18

What is the management for mitral regurgitation?

Answer 18

Primary severe MR
- Symptomatic regardless of LV function–> Surgery
o If high surgical risk and anatomy favourable to transcatheter approach and life expectancy >1y –> transcatheter edge-to-edge MV rapid (2a)

• Asymptomatic
  o LVEF <60% or ESD >40mm –> MV surgery
   Degenerative –> MV surgery
   Rheumatic –> MV repair

o Normal LV systolic function
- Expected surgical mortality <1% with >95% likelihood of successful surgery  MV repair at primary or CVC
- Progressive increase in LV size or decrease in LVEF on at least 3 studies  MV repair or replacement