Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiac Imaging > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Valvular heart disease — role of CMR ?

A

Cine Imaging: anatomy, coaptation, LV volumes/function

Phase Contrast Imaging: stroke volume (SV), regurgitant volume (RV), Vmax

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

Aortic valve stenosis — facts ?

A

Most common acquired valvular disease
Leads to left ventricular pressure overload
Leads to left ventricular hypertrophy

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

Aortic valve insufficiency — facts ?

A

Leads to left ventricular volume overload

Leads to left ventricular dilatation and secondary hypertrophy — concentric/symmetric, wall thickness <15mm

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

Mitral valve stenosis — facts ?

A

Leads to left atrial dilatation

Leads to pulmonary congestion / edema

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

Mitral valve insufficiency — facts ?

A

Leads to left ventricular volume overload
Leads to left atrial dilatation
Leads to pulmonary congestion / edema

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

Pulmonary valve stenosis — facts ?

A

Most frequent congenital valve disorder?
Leads to right ventricular pressure overload
Leads to right ventricular hypertrophy

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

Pulmonary valve insufficiency — facts ?

A

Common complication after repair of Tetralogy of Fallot (ToF) or pulmonary stenosis
Leads to right ventricular volume overload
Leads to secondary right ventricular hypertrophy

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

Tricuspid valve stenosis — facts ?

A

Rare valvular disorder

Leads to right atrial dilatation

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

Tricuspid valve insufficiency — facts ?

A

mild to moderate regurgitation is common
leads to right atrial dilatation
signs and symptoms are those of right sided heart failure, meaning ascites and peripheral edema etc.

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

aortic stenosis — aetiology ?

A

most common cause of valvular stenosis:
age > 70y degenerative
age < 70y congenital bicuspid
most common cause of subvalvular stenosis:
congenital postpartum characterised by a fibromuscular membrane within the outflow tract

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

aortic stenosis — epidemiology ?

A

most frequent valvular heart disease in Europe and North America
prevalence 2-5% after 65y, increasing with age
m>f 4:1

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

aortic stenosis — clinical symptoms ?

A

late symptoms with high grade stenosis

syncope, dizziness, dyspnea, angina

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

aortic stenosis — therapy and prognosis ?

A

aortic valve replacement
mortality after surgical valve replacement ~ 4% (~7% with bypass)
10 year survival rate ~ 85%

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

aortic stenosis — imaging (TTE) ?

A

AVA > 1.5cm2 / mpg < 25mmHg — mild stenosis
AVA 1.0-1.5cm2 / mpg 25-40mmHg — moderate stenosis
AVA < 1.0cm2 / mpg > 40mmHg — high grade stenosis
critical stenosis: < 0.7cm2 / mpg > 70mmHg
low-flow-low-gradient stenosis with AVA < 1.0cm2 -> bad prognosis
requires stress echo

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

aortic stenosis — imaging (CT) ?

A

calcium score: >2100 (m) / >1200 (f)
AVA > 1.5cm2 — mild stenosis
AVA 1.0-1.5cm2 — moderate stenosis
AVA < 1.0cm2 — high-grade stenosis

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

aortic stenosis — imaging (MRI) ?

A

AVA > 1.5 cm2 / Vmax <2.5m/s — mild stenosis
AVA 1.0-1.5 cm2 / Vmax 2.5-4m/s — moderate stenosis
AVA < 1.0cm2 / Vmax > 4m/s — high-grade stenosis
critical stenosis: < 0.7cm2 / mpg > 70mmHg
low-flow-low-gradient stenosis with AVA < 1.0cm2 -> bad prognosis
requires stress echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

aortic insufficiency — aetiology ?

A

acute: infectious endocarditis, vegetations, aortic dissection
-> rapid increase of left ventricular pressure
chronic: degenerative, rheumatic, bicuspid valves, collagenosis
-> slow elevation of left ventricular pressure and dilatation
surgical Carpentier classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

aortic insufficiency — Carpentier classification ?

A

Type 1: dilatation of the aortic root, normal valve
Type 2a: prolapse of one or more cusps (partial, complete, flail)
Type 2b: fenestration with eccentric jet
Type 3: destruction, irregular thickening, calcification of the cusps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

aortic insufficiency — epidemiology ?

A

prevalence ~ 4.9%
increasing with age
m:f - 3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

aortic insufficiency — clinical symptoms ?

A

acute left heart decompensation, pulmonary congestion

chronic left ventricular insufficiency, stress dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

aortic insufficiency — therapy ?

A

medications — reducing afterload

surgery — valve reconstruction or replacement (Ross operation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

aortic insufficiency — prognosis ?

A

10 year survival ~90% (grade 1/2) ~50 (grade 3)
left ventricular function is indicating surgery
5 year survival after surgery (EF>45%) ~85%, (EF<45%) ~50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

aortic insufficiency — imaging (TTE) ?

A

pressure half time assessment
mild AI: proximal jet width < 3 mm — PHT > 500 ms
moderate AI: proximal jet width 3-6 mm — PHT 200-500 ms
severe AI: proximal jet width > 6 mm — PHT < 200 ms
differentiation central (tricuspid) or eccentric jet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

aortic insufficiency — imaging (CT) ?

A

clarifying aetiology e.g. aneurysm, dissection, congenital
incomplete cusp coaptation, regurgitant orifice area (AROA)
< 25 mm2 — mild
25-75 mm2 — moderate
> 75 mm2 — severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

aortic insufficiency — role of MRI ?

A

visualisation of the diastolic regurgitant jet
clarification of the underlying aetiology
through-plane-phase-contrast measurement — regurgitant volume
calculation of the regurgitant volume (LVSV-RVSV) — requires competence of the other valves
planimetry of the effective regurgitant orifice area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

aortic insufficiency — grading ?

A

RV < 30 ml/beat, RF < 30%, ROA < 0.1 cm2 — mild
RV 30-60 ml/beat, RF 30-50%, ROA 0.1-0.3 cm2 — moderate
RV > 60 ml/beat, RF > 50%, ROA > 0.3 cm2 — severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

mitral stenosis — aetiology ?

A

rheumatic valve disease (95%)

obstruction e.g. myxoma, vegetations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

mitral stenosis — epidemiology ?

A

prevalence ~1%
age peak 50-70y
f:m - 2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

mitral stenosis — clinical symptoms ?

A

left atrial dilatation
pulmonary congestion
atrial fibrillation

30
Q

mitral stenosis — therapy ?

A

mitral valve reconstruction, valvuloplasty, mitral valve replacement
antiarrhythmic medications, anticoagulation

31
Q

mitral stenosis — prognosis ?

A

10 year survival in high-grade stenosis
50-60% in asymptomatic, ~15% symptomatic
valvulotomy/mitral valve replacement mortality rate 1-3%/ 3-8%
5 year survival ~ 90%

32
Q

mitral stenosis — imaging (TTE) ?

A

increased transvalvular pressure gradient
reduced mitral valve orifice area < 1.5 cm2 (high grade)
assessment of morphological changes e.g. doming, diffuse, irregular

33
Q

mitral stenosis — imaging (CT) ?

A

morphologic changes
quantification of the mitral valve orifice area < 1.5 cm2 (severe)
preoperative evaluation of coronary artery disease

34
Q

mitral stenosis — imaging (MRI) ?

A

visualisation of the diastolic jet
characterisation of tumors / vegetations
phase-contrast-imaging: Vmax
calculation of transvalvular pressure gradient: 5-10 mmHg (severe)
planimetry to assess the mitral valve orifice — 1.5 cm2 (severe)

35
Q

mitral insufficiency — aetiology ?

A

acute: papillary tendon rupture
rheumatic / inflammatory / traumatic / infarction (rare)
chronic: primary / secondary
primary: rheumatic-degenerative, mitral prolapse
secondary: dilatation of the mitral annulus (DCM, ischaemic CM)

36
Q

mitral insufficiency — epidemiology ?

A

most common mitral dysfunction

increasing with age, predominantly > 65 years

37
Q

mitral insufficiency — clinical symptoms and complications ?

A

acute: cardiogenic shock, reduced ejection fraction
chronic: left atrial then left ventricular dilatation, atrial fibrillation

38
Q

mitral insufficiency — therapy ?

A

surgical intervention indicated in high-grade insufficiency
also dependant on aetiology and pathophysiology
controversial in secondary functional aetiology e.g. DCM

39
Q

mitral insufficiency — prognosis ?

A

variable

higher mortality in moderate to high-grade insufficiency (EF<50%)

40
Q

mitral insufficiency — imaging (TTE) ?

A

VC: 1-3 mm, RV: < 30 ml, ROA < 0.2 cm2 — mild
VC: 4-6 mm, RV: 30-60 ml, ROA 0.2-0.4 cm2 — moderate
VC: > 7 mm, RV: > 60 ml, ROA > 0.4 cm2 — severe
also pressure half time calculation

41
Q

mitral insufficiency — imaging (CT) ?

A

clarification of the aetiology
visualisation of regurgitant orifice area (ROA) possible
surgical planning
characterisation of mitral annulus calcification

42
Q

mitral insufficiency — role of MRI ?

A

systolic regurgitant jet visualisation
clarification of aetiology: DCM, papillary infarct, HOCM, prolapse
calculation regurgitant volume (RV):
RV = LVSV-AoSV (PCI), RV = LVSV-RVSV (competence of other valves)
planimetry of the effective regurgitant orifice

43
Q

mitral insufficiency — MRI grading ?

A

RV < 30 ml/beat, RF < 30%, ROA < 0.2 cm2 — mild
RV 30-60 ml/beat, RF 30-50%, ROA 0.2-0.4 cm2 — moderate
RV > 60 ml/beat, RF > 50%, ROA > 0.4 cm2 — severe

44
Q

tricuspid stenosis — aetiology and epidemiology ?

A

post-inflammatory or congenital
rare disorder
often not diagnosed because of concomitant mitral stenosis
hemodynamically relevant: < 2.5cm2, severe: < 1cm2

45
Q

tricuspid stenosis — clinical symptoms and therapy ?

A

fatigue, edema
diuretics, salt restriction
balloon valvuloplasty — VOA < 1.7 cm2 or TVPG > 5 mmHg

46
Q

tricuspid stenosis — imaging ?

A

TTE — method of choice:
assessment of transvalvular pressure gradient
MRI — diastolic jet, right atrial dilatation, thickened valve

47
Q

tricuspid insufficiency — aetiology and epidemiology ?

A

valvular tricuspid insufficiency — rare
post-rheumatic, drug abuse, endocarditis, pacemaker wire
functional tricuspid insufficiency — fairly frequent
due to dilatation of the tricuspid annulus

48
Q

tricuspid insufficiency — clinical symptoms and therapy ?

A

fatigue and right heart insufficiency with edema
Natrium and fluid restriction
surgical therapy only with severe insufficiency
valve retaining techniques favoured

49
Q

tricuspid insufficiency — imaging ?

A

TTE — method of choice
MRI — right atrial and right ventricular enlargement
systolic jet into right atrium
quantification of regurgitant volume (RV)
RV = RVSV-PaSV (PCI)

50
Q

pulmonary stenosis — aetiology ?

A

congenital (80%)
mobile pulmonary valve with 2-4 raphes / commissures and incomplete separation
dysplastic pulmonary valve
subvalvular or infundibular as part of the ToF (tetralogy of Fallot)
supravalvular stenosis

51
Q

pulmonary stenosis — epidemiology ?

A

~8% of all congenital defects

~1:2000 of newborns

52
Q

pulmonary stenosis — clinical symptoms ?

A

mild — asymptomatic

moderate and severe — systemic venous congestion

53
Q

pulmonary stenosis — therapy and prognosis ?

A

therapy: watchful waiting, balloon-valvuloplasty, valvulotomy
prognosis: mild to moderate stenosis are well tolerated, high-grade stenosis lead to reduced ejection fraction, right heart hypertrophy, pulmonary congestion and cyanosis

54
Q

pulmonary stenosis — imaging (TTE) ?

A

method of choice in detection and grading
reduced mobility, reduced valve area
doming of the valve
pathological increased flow velocity in the main pulmonary artery

55
Q

pulmonary stenosis — imaging (CT) ?

A

anatomy of the right ventricular outflow tract
dilatation of the main and left pulmonary artery
thickened, immobile cusps
reduced size of the pulmonary annulus

56
Q

pulmonary stenosis — imaging (MRI) ?

A

morphology and anatomy of the right ventricular outflow tract
thickened, fused cusps, systolic doming
increased peak velocity (Vmax) and transvalvular pressure gradient
right heart hypertrophy

57
Q

pulmonary insufficiency — aetiology & epidemiology ?

A

valvular pulmonary insufficiency — rare
due to rheumatic fever, endocarditis
relative pulmonary insufficiency — more frequent
due to pulmonary hypertension of different aetiology e.g. fibrosis, mitral stenosis, left heart insufficiency or congenital defects or postoperative (surgical corrected ToF)

58
Q

pulmonary insufficiency — clinical symptoms ?

A

mild PI — asymptomatic

moderate to severe or long-standing — right sided heart failure with exertional dyspnea

59
Q

pulmonary insufficiency — therapy and prognosis ?

A

pulmonary valve replacement with progressing right cardiac failure
prognosis depends on the underlying aetiology

60
Q

pulmonary insufficiency — imaging (TTE) ?

A

method of choice
~75% with mild insufficiency are diagnosed
diastolic insufficiency jet for quantification

61
Q

pulmonary insufficiency — imaging (CT) ?

A

possible aid to find the underlying aetiology

62
Q

pulmonary insufficiency — imaging (MRI) ?

A

visualisation of the diastolic jet
assessment of regurgitant volume / fraction (PCI)
assessment of right ventricular function

63
Q

mitral prolapse — aetiology ?

A

degenerative: diffuse myxomatous degeneration (Barlow disease)
thickened leaflets with abundant myxomatous fibrous tissue
fibroelastic deficiency: decreased amount of fibrous tissue with thin walled leaflets and dilated annulus

64
Q

mitral prolapse — definition and forms ?

A

systolic protrusion of one or two mitral leaflets into the left atrium exceeding the mitral annulus more than 2mm
billowing form: due to myxomatous degeneration
flail form: protrusion of a free leaflet margin due to tendon rupture

65
Q

mitral prolapse — clinical symptoms, complications and therapy ?

A

~60% asymptomatic, otherwise diverse symptoms e.g. fatigue, angina, loss of autonomic function: panic attacks, depression
Complications: increased risk of endocarditis, mitral insufficiency
Therapy: only with progressing mitral insufficiency

66
Q

mitral prolapse — role of MRI ?

A

visualisation of the mitral valve
3ch to visualise A2/P2 prolapse additionally parallel views to depict A1/P1 and A3/P3 portions of the mitral valve
assessment of mitral insufficiency RV = LVSV-AoSV (PCI)

67
Q

calcification of the mitral annulus — facts ?

A

increasing with age, f:m — 4:1
risk factors: hypertension, diabetes, hyperlipidemia, metabolic syndrome
increased risk of CAD
increased risk of arrhythmia

68
Q

bicuspid aortic valve — definition and pathophysiology ?

A

2 functional cusps
congenital: conotruncal anomaly, developmental disturbance
acquired: fusion of a tricuspid valve e.g. after rheumatic fever
fusion most often occurs between the right and left coronary cusp (85%)
true valves with 2 cusps, 2 commissures, 2 sinus are less frequent

69
Q

bicuspid aortic valve — epidemiology ?

A

one of the most common congenital malformations
prevalence ~ 2%
associated with aortic coarctation and other congenital malformations
dilatation of the aortic root in ~ 80% with bicuspid valve

70
Q

bicuspid aortic valve — therapy ?

A

dependant on symptoms

e. g. valve replacement with severe valve or LV dysfunction
e. g. aortic replacement with severe dilatation of the aortic root

71
Q

bicuspid aortic valve — role of MRI ?

A

diagnosis
assessment of cusp mobility
detection and quantification of valve stenosis and insufficiency
evaluation of the aortic root / ascending aorta and LV function

Cardiac Imaging (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions