Valvulopathy

Question 1

Myxomatous Mitral Valve Degeneration

Demographics

Answer 1

• affects 1-2% of population

- 10% of those patients can progress

Question 2

Myxomatous Mitral Valve Degeneration

-Mitral Valve Repair indications

Answer 2

Repair is indicated when:

• chronic severe primary mitral regurgitation in symptomatic patients with LVEF >30%
• Asymptofatic with LV dysfunction (LVEF -30-60%/LV end systolic diameter >/= 40mm)
• Undergoing another cardiac surgical procedure

Question 3

LV Dysfunction in mitral regurgitation, criteria

Answer 3

-LVEF <60% since empties in atria as well

Question 4

Severity of Chronic Mitral Regurgitation

Answer 4

• echo is main modality to discern

- effective regurgitannt orifice area, regurgitant volume and flow

Question 5

Acute Mitral regurgitation Etiologies

Answer 5

• Ischemic: papillary muscle rupture 2/2 MI
• Nonischemic: ruptured mitral chodae tendinae 2/2 myxomatous disease (mitral valve prolapse), infective endocarditis, blunt chest trauma, rheumatic heart disease

Question 6

Classification of Chronic Mitral Regurgitation

Answer 6

• primary MR: abnormal mitral valve leaflets or chordae (w/ MVP leaflets are diffusely thickened and redundant, w/IE leaflet destruction and presence of valve vegetation)
• secondary (functional) MR: dilated mitral valve annulus due to cardiomyopathy (CAD vs non-ischemic)

Question 7

When to obtain TTE?

Answer 7

• appropriate in patients with cardiac symptoms and any cardiac murmur.
• also indicated in asymptomatic patients with a diastolic murmur, a grade 3 or greater systolic murmur, or a systolic murmur in association with other abnormal exam findings, such as a systolic click or reduced carotid upstroke.

Question 8

Severe MR Surveillance

Answer 8

-TTE and clinical exam every 6-12 months

Question 9

Aortic Coarctation

Answer 9

• HTN
• Radial - femoral artery delay
• rib notching (figure 3 on cxr)
• associated with bicuspid aortic valve (50% of patients), and cerebral artery aneurysm