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Week 3: Mitral Stenosis > Aetiology, LA and Suitability for Balloon Valvuloplasty > Flashcards

Aetiology, LA and Suitability for Balloon Valvuloplasty Flashcards

1
Q

What are the congenital causes of MS?

A
  1. Annular hypoplasia
  2. Anomalous mitral arcade
  3. Parachute MV
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2
Q

What are the echo characteristics of a Parachute MV?

A
  1. Single papillary muscle (A4C) placed more superiorly than normal
  2. Leaflets have reduced mobility as both leaflets are tethered to the same papillary muscle
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3
Q

Characteristic Features of Shone’s Syndrome?

A
  1. Supravalvular mitral ring/membrane
  2. Valvular mitral stenosis (parachute MV)
  3. Aortic coarctation
  4. Subaortic stenosis or BAV
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4
Q

What are the causes of acquired MS?

A
  1. Rheumatic MV Disease

2. Excessive MAC

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5
Q

Characteristics of Rheumatic MVD?

A
  1. Fusion of commissures
  2. Thickening and fibrosis of leaflets
  3. Leaflet calcification
  4. Thick, short and matted chords
  5. A ‘fish mouth’ orifice (reduced orifice)
  6. Calcification of commissures often occurs
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6
Q

What is the echo appearance of rheumatic MS?

A
  • Diastolic doming of MV leaflets: occurs due to commissure fusion
  • Pmvl shorter than amvl
  • Pmvl often fixed with restricted motion
  • Amvl looks like ‘hockey stick’ due to leaflet tethering
  • Commissure fusion with significant reduction in MV orifice (PSAX)
  • Subvalvular involvement may be seen; appears as short and thick chords (A4C with posterior tilting)
  • CFI shows ‘tunneling’ effect caused by subvalvular involvement
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7
Q

When is leaflet doming absent in MS?

A

If leaflets are excessively fibrosed or calcified

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8
Q

Examples of when is leaflet doming present in the absence of MS?

A
  • MV prolapse

- Mass lesions or vegetations involving free edge of amvl

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9
Q

When is there reduced MV opening in the absence of MS?

A

Reduced MV opening due to low cardiac output

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10
Q

Characteristics of Mitral Annular Calcification (MAC)?

A
  1. Commences at posterior aspect; progresses laterally
  2. Heavy MAC extends to body of leaflet and subvalvular apparatus => reduced mobility => functional MS
  3. Leaflet tips are spared
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11
Q

What is the echo appearance of MAC?

A
  1. Areas of increased echogenicity at mitral annulus
  2. Excessive MAC extends into mitral leaflets
  3. Mitral leaflet tips are usually spared
  4. Absence of commissural fusion
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12
Q

What differentiates MAC from rheumatic MS?

A
  • Absence of commissural fusion differentiates MAC from rheumatic MS
  • Rheumatic MS = commissural fusion
  • MAC = no commissural fusion
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13
Q

Other causes of LV inflow obstruction that can clinically mimic MS?

A
  1. Cor triatriatum (membrane transecting LA cavity)
  2. Large MV vegetations
  3. LA myxoma (tumour prolapses through MV during diastole and can mimic MS)
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14
Q

Affect of MS on LA size?

A
  1. MS decreases MVA which obstructs LA emptying during diastole
  2. Increased LAP leads to LA dilatation
  3. LA dilatation increases risk of AF and LA thrombus formation
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15
Q

How does LA thrombus form as a result of MS?

A
  1. Patients with MS prone to development of AF
  2. AF + dilated LA = stasis of blood flow which can lead to thrombus formation
  3. Thrombus formation most common in LAA
  4. SEC (‘smoke’) precursor for thrombus formation
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16
Q

What is Percutaneous Balloon Mitral Valvuloplasty?

A
  • PBMV procedure involves passing a balloon catheter from the RA into the LA via the IAS
  • Catheter then manipulated through MV into the LV
  • Preferred method of treatment for MS patients
  • Success rate dependent on anatomical MV appearance
17
Q

What is Wilkin’s Score?

A

Wilkin’s score predicts patient outcome for balloon valvuloplasty - if patient will have a good result from the procedure or not

18
Q

What categories are taken into account for Wilkin’s Score?

A
  1. Mobility
  2. Subvalvular thickening
  3. Thickening (leaflet)
  4. Calcification
    Each category graded 1 - 4 with a total score between 4 and 16
19
Q

What is considered a good/bad result for Wilkin’s Score?

A
  • A score ≤ 8 recognises patients most likely to have a good result
  • A score > 8 recognises patients less likely to have a good result
20
Q

What is the Padial Score?

A

Padial score is used to determine the degree of MR likely to occur following a balloon valvuloplasty

21
Q

What categories are taken into account for Padial Score?

A
  1. Leaflet thickening (amvl)
  2. Leaflet thickening (pmvl)
  3. Commissural calcification
  4. Subvalvular thickening
    Each category graded 1 - 4 with a total score between 4 and 16
22
Q

Significance of Padial Score for predicting severe MR?

A

A score ≥ 10 identifies patients likely to develop severe MR following balloon valvuloplasty

23
Q

Suitability of PBMV for patients with greater than mild MR?

A

PBMV requires splitting of MV commissures so patients with greater than mild MR are not suitable as further splitting could lead to severe MR

24
Q

Suitability of PBMV for patients with LA thrombus?

A
  • Presence of LA thrombus means manipulation of catheter in LA can lead to systemic embolisation
  • Therefore, these patients are not suitable for PBMV
  • TOE recommended for all patients being considered for PBMV to exclude LA thrombus

Week 3: Mitral Stenosis (3 decks)

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