Valve Disease

Question 1

MV Scallops at 0 degrees

Answer 1

A2 and P2

Question 2

MV scallops at 45 to 60 degrees

Answer 2

P1, A2, and P3

Question 3

MV scallops at 120 degrees

Answer 3

A1 and P1

Question 4

Most common fusions of the AV in bicuspid valve

Answer 4

R-L > R-N > L-N

Question 5

What is the DI?

Answer 5

LVOT_VTI/AV_VTI

Question 6

What DI indicates severe AS?

Answer 6

DI = 0.25

Question 7

What are the causes of low gradient AS

Answer 7

1. Measurement error
2. LVOT error
3. Low EF < 50%
4. Paradoxical > 50%

Question 8

Dobutamine protocol for low flow low gradient AS

Answer 8

5-20 mcg each 5 minutes

• SV should increase by 20%
• AVA = 1 or mean gradient >/= 40 for AS

Question 9

What is the general staging of AS

Answer 9

A: At risk

B: Progressive

C: Severe but no sx

D: Severe and sx

Question 10

What is the detailed grading of AS

Answer 10

C1: Compensated LV (>50%)

C2: Decompensated LV (<50%)

D1: High gradient

D2: LFLG

D3: Paradoxical LG

Question 11

What stage do we intervene on AS?

Answer 11

C2 or higher

Question 12

What conditions are associated with supravalvular AS

Answer 12

Williams syndrome

Bicuspid AV

Question 13

Screening intervals for AI

Answer 13

Mild: q 3 yrs

Moderate or higher: q 1 yr

Question 14

What indicates severe AI (9 criteria)

Answer 14

1. Wide defect
2. Large jet width
3. Steep PHT < 200
4. Prominent holodiastolic reversal
5. VC > 0.6
6. Jet width > 65% LVOT
7. RV > 60
8. RF > 50%
9. EROA > 0.3

Question 15

When to fix AI?

Answer 15

1. Severe and sx
2. Severe, no sx, EF <50%
3. Severe, no sx, EF >50% AND LVESD >50

Question 16

New requirements for severe MS

Answer 16

1. PASP > 30
2. MVA = 1.5 (<1 is very severe)
3. Diastolic PHT >/= 150 (220 for very severe)

Question 17

MVA from PHT

Answer 17

MVA = 220/PHT

Question 18

When is the PHT eqution unreliable?

Answer 18

1. Severe AI
2. Decreased LV compliance
3. Degenerative MS
4. Post BMV

Question 19

How does MVA relate to SV and VTI?

Answer 19

MVA = SV/MV_VTI

Question 20

Wilkins score

Answer 20

1. Mobility
2. Thickening
3. Calcification
4. Subvalvular stenosis

Question 21

What is severe MS with exercise?

Answer 21

1. MG > 15 with exercise
2. MG > 18 with dobutamine
3. RVSP > 60 with exercise

Question 22

What qualifies as severe MR?

Answer 22

1. EROA > 0.4
2. RF >50%
3. RV > 60
4. VC > 0.7
5. “E RF RV V”

Question 23

LAVI and mortality in MR

Answer 23

LAVI >60 with increased mortality

Question 24

Which TV leaflets are seen in each TTE window?

Answer 24

1. A4C: A-S
2. RV inflow: S-A
3. PSAX: P-S/A

Question 25

Parameters for severe TS

Answer 25

1. MG > 5.7
2. PHT >/= 190
3. TVA = 190/PHT

Question 26

Parameters for severe TR

Answer 26

1. VC > 7
2. ERO > 40
3. RV > 45

Question 27

Qualities of carcinoid

Answer 27

Need liver mets

Stenosis and regurg

If L sided involvement: shunt or pulmonary mets

Question 28

What is pathological obstruction in prosthetic aortic valve?

Answer 28

Accel time > 100 or DI < 0.25

Question 29

What is pathological obstruction in prosthetic MV?

Answer 29

MV PHT > 130

Question 30

What is pathological regurg in prosthetic MV

Answer 30

PHT < 130 and TVI > 2.2

Question 31

What defines periprosthetic regurg?

Answer 31

PHT <200 and circumferential percent > 30%

Question 32

Requirements for successful MitraClip

Answer 32

Flail width <15

Flail gap < 10

P2/A2 involvement

Question 33

What is high risk for IE?

Answer 33

Large vegetations, prosthetic valve, perivalvular extension, and lots of regurg

Question 34

What is an acquired Gerbode defect?

Answer 34

IE causing RA-LV fistula