Mitral Valves

Question 1

Which MV leaflet has larger surface area but occupies only 1/3 of annulus?

Answer 1

Anterior

Question 2

Which MV leaflet has smaller surface area but occupies 2/3 of the annulus?

Answer 2

Posterior leaflet

Question 3

What to look for opinion cath tracings for MS?

Answer 3

At diastole, LAP»LVP

Question 4

What valve area, mean gradient, and systolic PAP defines moderate MS?

Answer 4

MVA: 1-1.5cm
Mean grad : 5-10
PAP: 30-50

Question 5

What stage of MS is asymptomatic, MVA150ms, severe LAE?

Answer 5

C

Question 6

What stage of MS is symptomatic, MVA150ms, severe LAE?

Answer 6

D

Question 7

What does it mean when opening snap in MS is early?

Answer 7

MS is severe

Question 8

If a pt with MS develops Pulm HTN, what is their median survival in years?

Answer 8

<3 y

Question 9

Besides MV replacement, what is a surgery for MS?

Answer 9

Mitral commissurotomy

Question 10

Wilkins score for MS gives 4 points to each of the following:

Answer 10

• leaflet thickening
• leaflet calcification
• leaflet mobility
• subvalvular thickening

Question 11

What MVA is considered severe MS?

Answer 11

<1.5cm

Question 12

According to 2014 guidelines, if a pt has Progressive MS (MVA>1.5cm, PHT<150ms) but has sxs with no other cause, what is best next step?

Answer 12

See if PCWP >25 with exercise, and if so, you can do PMBC (IIb)

Question 13

What ERO and Regurgitant Volume define severe MR?

Answer 13

ERO> 40

RVol> 60

Question 14

With normal LA and LV, can MR be severe?

Answer 14

No

Question 15

Causes of MR

Answer 15

Rupture (Pap m, chordal, leaflet)
Endocarditis
MVP
ischemia
Rheumatic

Question 16

In acute MR, how loud will murmur be?

Answer 16

Soft

Question 17

What stage if MR is asymptomatic, severe (jet area >40% LA, RVol>60cc, ERO>.4, LAE, PHTN) and EF>60%/LVESD<40mm?

Answer 17

C1

Question 18

What stage if MR is asymptomatic, severe (jet area >40% LA, RVol>60cc, ERO>.4, LAE, PHTN) and EF40mm?

Answer 18

C2

Question 19

What stage of MR is severe, sxs (dec ET)?

Answer 19

D

Question 20

Type I MR mech

Answer 20

Annular dilatation

Question 21

Type II MR Mech

Answer 21

Excessive leaflet motion (MVP, flail)

Question 22

Type IIIa and IIIb MR mech

Answer 22

IIIa- restricted leaflets in diastole

IIIb- restrict leaflets in systole

Question 23

In type II MR, which way is jet directed?

Answer 23

Away from abnormal leaflet

Question 24

Example of type IIIb MR

Answer 24

Ischemic

Question 25

What variable on echo determines the natural history CV event rate associated with MR?

Answer 25

ERO

Question 26

Class I indication for stage C2 MR?

Answer 26

MV surgery

Question 27

What is the treatment algorithm if pt has severe MR (vena contracta >.7, ERO>40, RVol>60) and pt has sxs (Stage D)?

Answer 27

See if EF> 30%, if yes, then MV Surgery (I)

If not, IIb

Question 28

What is treatment algorithm for a patient with severe MR (vena contracta >.7, ERO>40, RVol>60), asymptomatic , LVEF 30-69%, LVESD> 40mm?

Answer 28

MV Surgery (I)

Question 29

If pt has severe MR (vena contracta >.7, ERO>40, RVol>60) and new AF or PASP> 50 (stage C1), what is treatment algorithm ?

Answer 29

MV Repair if likelihood of success is >95% with low mortality (IIa)

Question 30

Treatment algorithm for severe MR, sxs, EF<30% and chordal preservation unlikely

Answer 30

Medical Rx

Question 31

for MR, is repair or emplacement preferable?

Answer 31

Repair

Question 32

Whi regards to MV segments, which one is medial and which is lateral?

Answer 32

Medial= 3 
Lateral = 1