CARDIAC Section 3: Valves

Question 1

What does this image demonstrate?

What’s the diagnosis?

Answer 1

Regurgitant jet in a Three chamber cardia MR still image

Aortic Regurgitation

Question 2

What planes do you use to see the Stenotic/regurgitant Flow jets

Answer 2

Orthogonal planes

Question 3

What is a set parameter of phase-contrast imaging used for quantifying the velocity of flowing blood?

Answer 3

Velocity-encoded cine MR (VENC)

Question 4

In VENC, what happens if the velocity range is too low?

How should you set it?

Answer 4

You will get the classic ALIASING artifact

Select a velocity 20-25% highger than the expected maximum

Question 5

Identify the valve

Answer 5

Aortic valve

Question 6

What is the most SUPERIOR valve of the heart?

Answer 6

Pulmonic valve

Question 7

What is the most ANTERIOR valve of the heart?

Answer 7

Tricuspid Valve

Question 8

What’s above and What’s below?

Answer 8

Aortic above

Mitral belowW

Question 9

What modality is the best first choice to look at the valveS?

Answer 9

ECHO

Question 10

What MRI slices allow you to quantify the regurgitant volume?

When is it measured?

Answer 10

Transverse slices positioned at the valve - during diastole

Question 11

What causes AORTIC STENOSIS?

Answer 11

Congenital - BISCUPID

Acquired - Degenerative or Rheumatic Heart

Question 12

What cardiac condition is linked with increased afterload and concentric LV hypertrophy?

Answer 12

Aortic stenosis.

Question 13

What imaging technique is used to quantify the velocity of blood flow in aortic stenosis?

Answer 13

Velocity-encoded cine MR imaging (VENC) or phase-contrast imaging.

Question 14

What causes dilation of the ascending aorta in aortic stenosis?

Answer 14

Jet phenomenon related to a stenotic valve.

Question 15

Name the three types of aortic stenosis.

Answer 15

Valvular, subvalvular, and supravalvular.

Question 16

What syndrome is associated with supra-valvular aortic stenosis?

Answer 16

Williams Syndrome.

Question 17

What condition is indicated by bicuspid aortic valve and coarctation?

Answer 17

Turner’s Syndrome.

Question 18

What percentage of the general population is affected by bicuspid aortic valve?

Answer 18

Nearly 2%.

Question 19

What is the most common congenital heart disease?

Answer 19

Bicuspid aortic valve.

Question 20

What is a significant complication of bicuspid aortic valve?

Answer 20

Aortic stenosis.

Question 21

What syndrome is associated with bicuspid aortic valve?

Answer 21

Cystic Medial Necrosis
Tuerners Syndrome
Coarctation
AD Polycystic Kidney Disease

Question 22

What is the most common Variant of Bicuspid Aortic Valve?

Answer 22

Type I Variant

Question 23

What is an independent risk factor of aortic aneurysm

Answer 23

Bicuspid Aortic Valve

Question 24

What are some causes of aortic regurgitation?

Answer 24

Bicuspid aortic valves, bacterial endocarditis, Marfan’s syndrome, hypertension-caused aortic root dilation, and aortic dissection.

Question 25

What determines the hemodynamic impact of aortic regurgitation?

Answer 25

The rapidity of onset. "Austin Flint Murmur"

Question 26

What is the most common cause of mitral stenosis?

Answer 26

Rheumatic heart disease.

Question 27

What are some radiological signs of mitral stenosis on a chest X-ray?

Answer 27

Double density sign, splaying of the carina, posterior esophageal displacement, walking man sign Basically LA cardiomegaly

Question 28

Name the three types of pulmonary stenosis.

Answer 28

Valvular, subvalvular, and supravalvular.

Question 29

What syndrome is associated with valvular pulmonary stenosis?

Answer 29

Noonan's Syndrome

Question 30

What syndrome is associated with SUPRA-valvular pulmonary stenosis?

Answer 30

William's Syndrome

Question 31

What syndrome is associated with SUBalvular pulmonary stenosis?

Answer 31

TOF

Question 32

What condition is commonly seen with Alagille syndrome?

Answer 32

Peripheral pulmonary stenosis.

Question 33

What is the primary complication following TOF repair?

Answer 33

Pulmonary regurgitation.

Question 34

What is crucial for timing the repair of pulmonary regurgitation?

Answer 34

Cardiac MRI, to assess RV dilation.

Question 35

What involves patch repari of the VSD and relief of the RV outlet obstruction?

Answer 35

TOF repair involves patch repair of the VSD and relief of the RV outlet obstruction.

Question 36

What is the most common form of tricuspid disease?

Answer 36

Tricuspid Regurgitation (weak annulus compared to mitral)

Question 37

What are some causes of tricuspid regurgitation?

Answer 37

Pulmonary arterial hypertension (MOST COMMON) Endocarditis (especially in IV drug users), Carcinoid syndrome (serotonin degrades the valve)

Question 38

What is the effect of tricuspid regurgitation on the right ventricle?

Answer 38

It causes RV dilation, not RV hypertrophy.

Question 39

What are the common vavles involved in Rheumatic heart disease?

Answer 39

MV AV

Question 40

When there is Multivalve disease, think of?

Answer 40

Rheumatic Fever!

Question 41

What heart disease is an immune modulated response to Group A- Beta hemolytic strep?

Answer 41

Rheumatic Heart Disease

Question 42

What maternal factor is associated with Ebstein Anomaly in children?

Answer 42

Use of Lithium during pregnancy.

Question 43

Describe the cardiac abnormalities in Ebstein Anomaly.

Answer 43

Hypoplastic tricuspid valve, apically displaced posterior leaf (downward), enlarged right atrium, decreased right ventricle ("atrialized"), and tricuspid regurgitation.

Question 44

Diagnosis?

Answer 44

Ebstein Anomaly

Question 45

What effect does carcinoid syndrome have on heart valves?

Answer 45

It causes valvular disease, typically affecting the tricuspid and pulmonic valves, due to serotonin degrading the valves.

Question 46

When is left-sided valvular disease seen in carcinoid syndrome, and what are two scenarios to consider?

Answer 46

Left-sided disease is rare and suggests either a primary bronchial carcinoid or right-to-left cardiac shunts.