Mitral valve

Question 1

Mitral valve anatomy

Answer 1

intervalvular fibrosa between MV/AV- susceptible to abscess and fistulas

left and right trigones between MV/ AV

PM pap muscle most likely to rupture from single blood supply (PDA)

Both leaftlets attached by chordae from both paps

High/short/AP axis < 36 mm during systole
low/long/commisural axis <46mm

Question 2

ME LAX view uses

Answer 2

Vena contracta
MV prolapse (p2 especially)
End systolic ap annulus >36 mm

Question 3

TG basal SAX view use

Answer 3

Clefts
location of regurgitation (not severity)

Question 4

TEE eval of MR

Answer 4

severity
mechanism
location of lesion
repairable?

Question 5

causes of MR

Answer 5

Myxomatous most common in west
rheumatic most common in developing nations
ischemia
cardiomyopathy
endocarditis
congenital
connective tissue disorders

Question 6

Direction of jets

Answer 6

normal leaflet motion - central
excessive leaflet motion - away from dz leaflet
restrictive leaflet motion isolated- toward dz leaflet
restrictive leaflet motion bilateral - central

Question 7

leaflet motion

Answer 7

billowing -leaflet tip does not come up
prolapse- leaflet tip is elevated
flail- leaflet tip is free

Question 8

Grading MR moderates

Answer 8

Ajet/Aatria 20-40%
VC 3-7mm
MR jet area 4-10 cm2
PV flow s<d
MR fraction 30-49%
Rvol 30-59 mL
EROA 0.2-0.39cm2
PISA rad >1cm at 40cm/s is severe
CW strength - moderately dense

Coanda effect = severe

Question 9

v wave cutoff sign

Answer 9

happens in acute severe MR where the MR jet CWD decreases rapidly after peak and is not symmetrical .

Associated with v wave on LAP or PCWP tracing

Question 10

SAM after repair

Answer 10

2-16% with MV repair

Only time that MV regurgitation doesnt go towards restricted leaflet (directed posterior away from problem)

AL/PL ratio <1
Csept <2.5 cm

Question 11

Mitral stenosis

Answer 11

Rheumatic most common cause
LA myxoma , MAC, thrombus, parachute MV, congenital, subvalvular ring, cortriatriatum sinister also can cause

Question 12

Calculating MVA

Answer 12

planimetry- TG basal SAX
PHT - 220/PHT
DT - 759/DT
Continuity - Alvot x TVIlvot / TVImv
PISA- Qpisa/ Vpeak
3d planimetry

Question 13

Grading MS moderates

Answer 13

Mean gradient - 5-10 mmHg
PHT - 151-219 msec
MVA - 1-1.5 cm2

Question 14

limitations of PHT for MS

Answer 14

decreased lv compliance can underestimate MS
Severe AI as well

Question 15

limitations of mean gradient on MS

Answer 15

increase LAP - overestimate
Angle of incidence- underestimate
decreased LV compliance- overestimate
impaired relaxation-underestimate
increase HR-overestimate
increase sv- overstimate

Question 16

PISA

Answer 16

proximal isovelocity surface area
Ahole x Vpeak = PISA x Valias

Question 17

Hemodynamic calculations of mitral valve

Answer 17

rvol = EROA x VTImr
or SVmv inflow - SVav(lvot)

Regurg Fraction= rvol/SVmv inflow