Valves

Question 1

Valvular surveillance

Answer 1

Severe 6-12 months
Moderate 1-2 years or (12-18 AS)
Mild 3-5 years

Question 2

Mitral Valve Carpentier Classification

Answer 2

Type I - normal leaflet motion
Type II - excessive leaflet motion
Type III - restrictive leaflet motion
a) inflammatory rheumatic (systole and diastole)
b) MI, chord rupture, LV dilated (restricted in diastole)

flail: chordal rupture typically P2
Prolapse: must be visible in more than 1 view

Coaptation Zone
normal: < 2mm above annular plane

Question 3

Mitral Stenosis PHT

Answer 3

Normal valve: LA/LV pressure equalises quickly mid diastole

MS: stiff, small vol blood flows, LA/LV pressures don’t equalise or delayed, maintains pressure gradient across valve

Underestimate:
Anything increasing LV pressure/preload reduces pressure gradient so underestimate difference (AS, AR, LV diastolic dysfunction)

Overestimate:
Increased LA pressure, increases pressure across valve (MR)

Pressure gradient (PHT) not accurate in abnormal flow state

MS PHT: mild 70ms, mod 140ms, severe 220ms
MVA = 220 / PHT
MVA: mild 2.0cm2, severe <1.0cm2
SPAP: mild 30mmHg, severe >50mHg

Question 4

Valve normal Sizes

Answer 4

Pulmonary 2-4cm
Aortic 2-4cm
Mitral 4-6cm
Tricuspid 9-11cm

Question 5

Mitral Valve Prolapse

Answer 5

1 or both leaflets >2mm above annular plane in PLAC or A3C

Isolated MVP good prognosis follow up 3-5yrs

Associated w/ Marfan’s and Ehlors D

Question 6

MR

Answer 6

Best visualised PLAX or A2C

Indications for surgery:
Severe asymptomatic MR w/ LV dilatation, AF, PHT

Question 7

Mitral Stenosis

Answer 7

Rheumatic fever most common then degenerative

Posterior leaflet moves anterior towards anterior leaflet instead of apart when opening

Delayed MV closure till late diastol

Question 8

EROA and VC are independent of LV function or flow/loading conditions