Mitral Valve

Question 1

what should you always report with the MV gradient?

Answer 1

HR

Question 2

Diagnosis?

Answer 2

MS

Question 3

why do a TEE before Mitral valvuloplasty for rhematic MS?

Answer 3

r/o LA thrombus or >2+ MR

Question 4

Wilkins score components and when to send to vavluloplasty

Answer 4

<8

valve mobilty

subvalvular thickening

valve thickening

calcification

Question 5

can you use PHT to calculate MVA 24-48h after valvuloplasty?

Answer 5

no

Question 6

which slope do you use to calc MVA if you have 2 deceleration slopes?

Answer 6

the one with the longer duration

Question 7

when can you not use the continuity eq’n to calculate MVA?

Answer 7

> mild MR or AR

Question 8

PISA Eq’n for MVA

Answer 8

Diastolic Flow/Vmax

(Diastolic Flow = 6.28 x (r^2) x Vr x a/180)

Question 9

if you use continuity eq’n to calculate MS, what happens if there is MR? AR?

Answer 9

MR–> overestimate MS

AR—> Underestimate MS

Question 10

when does an increased PHT not mean MS?

Answer 10

abnormal relaxation (E velocity not increased) or MG normal

Question 11

What is MV PHT shortened by?

Answer 11

AR and Decreased LV compliance

Question 12

Diagnosis

Answer 12

Radiation MS

Question 13

Diagnosis

Answer 13

Parachute MS

Question 14

Diagnosis

Answer 14

Medication Induced MS (small/retracted leaflets with thick tips

Question 15

Diagnosis

Answer 15

MVP

Question 16

Diagnosis

Answer 16

SAM

Question 17

Definition of MVP

Answer 17

>2mm systolic displacement of one or both leaflets into LA below plane of mitral annulus

Question 18

If your MV leaflet in PLAX looks like its prolapsing into LA, but the distant from annular plan to prolapsed leaflet is <2mm- what do you call it?

Answer 18

bowing

Question 19

At what ERO is ischemic MR severe? organic?

Answer 19

ischemic–> ERO> .2 cm^2

organic–> ERO > .4

Question 20

which MR is more severe?

Answer 20

the top one (more dense jet, holosystolic vs. end-systolic only)

Question 21

name 5 SPECIFIC signs of severe MR

Answer 21

VC > .7

large central jet or wall-hugging/LA-swirling jet

Large flow convergence

systolic flow reversal in PV

prominent flail or ruptured pap

Question 22

Name 3 SUPPORTIVE (not specific) signs of severe MR

Answer 22

Dense/triangular CW of MR

E > 1.2 m/s

Large LA/LV

Question 23

ERO, RVol, RF indicating mild and severe MR

Answer 23

ERO <.2, >0.4

RVol <30, > 60

RF <30, > 50%

Question 24

Diagnosis in each picture

Answer 24

PV systolic damping and Systolic flow reversal (from severe MR- goes UNDER the baseline)

Question 25

VC in mild MR? Severe MR?

Answer 25

<.3 cm

>.7 cm

Question 26

Diagnosis

Answer 26

Flail P2 (MV)

Question 27

Diagnosis

Answer 27

SAM

(Posteriorly directed jet for severe MR on TEE- ALWAYS LOOK FOR THE SAM)

Question 28

In patients w/ SAM (LVOT obstruction), if they have failed BB/CCB, what other negative inotrope can be used?

Answer 28

disopyramide

Question 29

3 characteristics of Rheumatic MS

Answer 29

calcified leaflet tips

fish mouth

hockey stick leaflet in PLAX

Question 30

DT x 0.29 = ?

Answer 30

PHT

Question 31

750/DT = ?

Answer 31

MVA

Question 32

Normal range for peak E wave velocity

Answer 32

.8-1

Question 33

how severe cna MR be if A > E wave?

Answer 33

not very severe

Question 34

what is NOT ok to use after MV valvuloplasty to obtain MVA? what DO you use?

Answer 34

dont use PHT or Planimetry!

DO use Continuity eq’n