Valvular heart disease board review

Question 1

4stages of VHD

Answer 1

A at risk
B progressive
C. severe asx c1 compensated LV or RV C2 deccomistated LV or RV
d. Severe sx

Question 2

CHF AHA stages of HF

NYHA classes /CCS

Answer 2

A. at risk
B. asx with chf
C. sx
D. refractory

I. asx
II. Mild limitations - >1 flight, > 2 blocks
III. mod limitations - 1 flight of stairs or 2 blocks
IIII.Severe limitations - at rest, limited activity

Question 3

Frequecny of echo follow up for VHD

Answer 3

Stage B 3-5 years Stage C 6 mo to 1 year.

Question 4

STS risk given high risk

Answer 4

> 8%

Question 5

How many frailty on katz make someone high risk

What about prohibitive risk

Answer 5

2 or more

> 50% n1 year predicted risk of death

Question 6

AVA index associated with severe

Answer 6

< 0.6

Question 7

SV index for low flow

Answer 7

< 35 ml/M2

Question 8

What can mask a high gradient with AS

Answer 8

HTN (need to control bp) needs to be less than 140 for accurate assessment

Question 9

TAVR vs SAVR GL recs based on risk

Answer 9

Low risk SAVR Class I
Intermediate risk SAVR Class I , TAVR IIa
High risk SAVR or TAVR class I
Prohibitive risk TAVR class I

Question 10

How to decided TAVR vs. SAVR for intermiediate risk

Answer 10

Class I SAVR and Class IIa TAVR, Need heart team decision

Question 11

AI surgical replacement

Answer 11

severe at and sx or asx and severe LV dilation SVESD > 50 mm / 25 indexed or LVEDD > 65 (note for MR its only 40 mm ESD)

Question 12

in asx pt with AI do you give someone a ACEor ARB

Answer 12

No need unless htn or sx with severe dz

Question 13

problem with BB and AR

Answer 13

longer diasotolic interval with slower HR and then get more AR. (slow stenotic lesions and keep regurgitant lesions fast.)

Question 14

What size ventrical can you replace the AV in an asx individual; with severe AR

Answer 14

1. 5 cm EsD or 25 cm indexed , 65 EDD

Question 15

1. what is the most common fusion for BAV
2. this leads to dilatation

Second most common type of BAV?

Answer 15

right and left

of the tubular portion bc jet blows ant and to the right

right and non cusps (this is assocaiated with a higher location of the aortaopthy tubular to arch)

Question 16

PAtient not a candidate for BAV for their MS important board point

Can do MV BAV in an asx patient

Answer 16

Need to be NYHA III or IV this is the only deisease when don’t need to be NYHA class II and that is bc of high mortality and f need for repelacment.

2. yes if MVA is < 1.

Question 17

Mod MR and Severe MS MVA of 1.4 cm 2 and patient is sob but went 8 min on bruce

Answer 17

wait until class 3 or develop PH or afib, control HR

Question 18

Always the right answer when its availible

Answer 18

mitral valve repair

Question 19

Compacted vs. noncompacted myocardium size

Answer 19

2:1 ratio

Question 20

wilkins score cut off for mitral BAV

Answer 20

<= 8 optimal outcome with bav

Question 21

guideline rec for MV repair or replace if severe fMR and cardiac surgery

2. ***mFMR and other CTS, will be asked this

Answer 21

IIA

IIB!

Question 22

how large is an enlarged Triculspid annular dimention in diastole on the 4 chamber view

Answer 22

40 mm or > 21 mm/m2

Question 23

Class I indication for Tricuspid surgery

IIa

Answer 23

referred for conocmiant left valve surgery nwith severe TR. (repairs)

IIa - repeari TV server for severe secondary TR if annular dilation > 40 or indexed 21 mm or hx of right sided HR.

Note these are left sided valve surgeries not cabg

Question 24

when can do TV surgery in setting of primary tr

Answer 24

in patient with refractory sx. IIa and severe primary TR.

Question 25

What severeity of oprimary MR will allow you to replace /repair the mitral valve

Mneumonic

Answer 25

Symptomatic severe MR
Severe MR = VC > 0.7 R vol > 60 ml ERO > 0.4 LV dilatation RF > 50%

Menumonic 
7 - VC 0,7
6 rvo 60 ml
5 RF 50% 
4 0.4 
\+ LV dilatation LVESD > 4.0 mm 
*caviat surgery in low EF MV may be dangerous. 

What EF can go to OR with severe MR <=-60 or LVESD > 40

also note if EF > 60 and LVSD < 4 but > 95% chance of successful repain and mortality less than 1% can go tosurgy if asx. otherwise monitor.

Question 26

Class I indications for surgery for I.E. prior to completeion of course of abx.

Answer 26

1. Valve dysfunction causing symptomatic CHF
2. left sided endocariditis caused by staph arusus fungus or other highly resisitant organic
3. Abcess or inidications of abcess ie heart block
   4, persitiant infection > 5 days bacterime/fevers despite appropriate abx
   protthetic valve IR + replalpsing infecitons
   IE with recurrent emboli and perisitent veg (iia)
   naitice IE with mobile veg > 1 cm (10 mm) in length (thing on is a IIb) not indiciated

Question 27

If have staph endocariditis and have a ppm without involvement what is the rec

Answer 27

complete removal of the AICD regardless of evidience IIa

Class I inf they show sigs of involvement

Question 28

surgery on TV for I.E.

Answer 28

only if symtomtic HF, abcess, perisistnet infection, prosthetic with relpapsing infection.

Question 29

after valve placed how often need echo

Answer 29

not until 10 years there after yearly or with sx (this is insane)

Question 30

recs for AC with biorpsotetic bvalve

Answer 30

3 months or 6 months if low bleeding risk in addition to asa. (note only for mitral)

Question 31

mechanical AVR without hifh risk don’t need briding.

Answer 31

don’t need briging

Question 32

two times cannot use doacs

Answer 32

mechanical valves and > mod MS with AF (that is it). If no AF or stroke hx no need to AC Mod AS.

Question 33

Thrombosis vs. emergency surgyery for thrombosed valve

Answer 33

if CHF NYHA III/iv emergency sugery (class I) 
if <= 0.8 and No severe CHF fibrinolysis, if > 0.8 surgery