Valvular disease Flashcards
(111 cards)
1
Q
Inlet valves
A
Mitral and tricuspid
2
Q
Outlet valves
A
Aortic and pulmonary
3
Q
Valves are defined by their
A
Downstream chamber or vessel
4
Q
Primary function of cardiac valves
A
Provide minimal resistance to forward flow, while preventing backward regurgitant flow
5
Q
Mitral valve apparatus is comprised of the
A
Valve leaflets (anterior and posterior), chordae tendinae and papillary muscles
6
Q
The 2 mitral valve leaflets are each divided into how many scallops and clefts
A
3 scallops separated by 2 clefts
7
Q
Largest scallop of mitral valve
A
Middle
8
Q
Continuous fibrous ring that surrounds the mitral valve leaflets
A
Mitral annulus
9
Q
Supplies the anterolateral papillary muscles
A
Left anterior descending coronary artery or the left circumflex coronary artery
10
Q
Posteromedial papillary muscle is generally supplied by the
A
Right coronary artery
11
Q
3 leaflets of tricuspid valve:
A
Anterior, posterior and septal leaflets
12
Q
3 papillary muscles of tricuspid valve
A
Anterior, posterior and septal
13
Q
The anterior papillary muscle of tricuspid valve can attach to
A
Anterior leaflet alone or to both anterior and septal leaflets
14
Q
Posterior papillary muscle of tricuspid valve can attach to the
A
Posterior and septal leaflets
15
Q
Septal papillary muscle of tricuspid valve cqn attach to
A
Septal and anterior leaflets
16
Q
aortic and pulmonary valves are named according to
A
sinus of Valsalva from which coronary arteries typically arise
17
Q
the noncoronary cusp is typically located where
A
posterior
18
Q
left and right cusps of aortic and pulmonary valves usually abut or face the
A
pulmonary valve, referred to as the “facing” sinuses of Valsalva
19
Q
aortic and pulmonary valves opens during
A
ventricular systole
20
Q
aortic and pulmonary valves closes at the
A
end of ventricular systole, as the pressure in the RV drops
21
Q
can be seen as “O” or “C”-shaped dense structure at the expected location of the mitral annulus
A
mitral annular calcification
22
Q
chronic degeneration of the fibrous ring of the mitral valve and may be seen in younger patients with renal disease or abnormal calcium metabolism
A
mitral annular calcification
23
Q
these valves are not well evaluated in echocardiography due to their position
A
pulmonary and tricuspid valves
24
Q
clinical gold strandard for noninvasive measurement of blood flow and is routinely used to quantify the severity of valvular stenosis or regurgitation
A
phase contrast MRI
25
measurements of blood flow in phase contrast MRI are typically performed where
perpendicular to the direction of blood flow, centered in the vessel or valve of interest
26
for valuvular stenosis, peak velocities are measured where
near or just distal to the location of severe stenosis
27
for valvular regurgiation, two approaches are commonly used in phase contrast MRI
measuring the amount of regurgital flow below a zero baseline near the valve or vessel of interest, directly measuring the regurgitant jet during the systolic portions of the cardiac cycle where regurgitation is observed
28
two primary metrics in valvular regurgitation
RVol and RF
29
defined as the amount of blood flow backward through the valve and is typically defined in units of either liters per minute or milliliters per beat
RVol
30
defined as RVol divided by the forward flow volume
RF
31
Most common CHD, in which two of the leaflets of the aortic valve may be partly or completely fused, resulting in a two-cusped valve rather than the normal three cusped valve
Bicuspid aortic valve
32
Bicuspid aprtic valve is associated with
Aortopathy, aneurysm, aortic dissection and rupture, aortic coarctation; with approximately half demonstrates dilatation of the aortic root and proximal ascending aorta
33
most common type of subaortic stenosis, typically resulting in murmur
subaortic membrane
34
acquired aortic valve disease is often caused by
degenerative calcification and chronic leaflet deterioration
35
most common valve disease, generally occurring among older patients
aortic stenosis
36
aortic valve area is determined by ______, which states that the blood flow passing through a tube must be equal, measured at any location along that tube, in order to satisfy conservation of mass
continuity equation
37
AVAs below ____ cm2 are considered moderate
1.5 cm2
38
AVAs below __ cm2 are considered severe
1 cm2
39
AVAs less than ___ cm2 are considered critical
0.5 cm
40
severe aortic valve stenosis typically correlates with peak aortic velocities over __ m/s mean gradients exceeding ___ mmHg
4 m/s; 40 mmHg
41
management for severe aortic stenosis
surgical aortic valve replacement or transcatheter aortic valve replacement (TAVR)
42
preprocedure planning for TAVR is now routinely performed with cardiac ct, for measurement of
size of the aortic annulus, evaluation of vascular access, and prediction of projection angles for prosthesis deployment
43
aortic annulus is typically measured in
systole in a double oblique plane immediately below the hinge points of the aortic valve cusps
44
presents as initially increased total left ventricular stroke volume through compensatory mechanisms, resulting in dilation and concentric left ventricular hypertrophy
aortic regurgitation
45
aortic regurgitation is measured qualitatively by _____, but when needed for clinical management, RVol and RF can be quantified through ______
quali- echocardiography, quanti- MRI
46
defined as bowing or prolapse of the mitral leaflet of 2 mm or beyond the annular plane into the LA in ventricular systole
mitral valve prolapse
47
most common cause of sever nonischemic mitral regurgitation
MVP
48
MVP is caused by
rupture or elongation of the chordae tendinae
49
most commonly involved mitral leaflet in MVP
middle scallop of the posterior leaflet (P2 segment)
50
prolapsed mitral valve scallop is classified as a _____ (with bowing of the leaflet body) or _____ (with free leaflet edge prolapse)
billowing leaflet and flail leaflet
51
conditions that are associated with secondary MVP include
connective tissue disorders (such as Marfan) and CHD (ostium secundum ASD and aortic coarctation)
52
characterized by division of one of the mitral leaflets
mitral cleft
53
typically involved leaflet in mitral cleft
anterior
54
cleft mitral valve is associated with
progressive mitral regurgitation
55
in this condition, the mitral cleft is oriented toward the LVOT rather than the inlet septum, as is the case of patients with endocardial cushion defect (AVSD)
isolated mitral cleft
56
this condition can occur congenitally with hypoplasia of the mitral valve annulus, fusion of the mitral valve commissure and shortened or thickened chordae tendineae
mitral stenosis
57
mitral stenosis can be seen in association with
multiple left-sided cardiac anomalies in what is known as Shone complex, including parachute mitral valve or supramitral ring
58
mitral stenosis is often congenital or acquired
acquired (most commonly due to RHD)
59
MS characteristically results in ______ as a compensatory mechanism in order to maintain normal cardiac output
increased LA pressure
60
increased LA pressure in this condition presents with LA enlargement and increased pulmonary venous pressure, eventually leading to pulmonary hypertension
MS
61
noninvasive clinical standard for assessing severity of MS
transmitral gradient, measured by Doppler echocardiography, combined with mitral valve planimetry and pressure half-time
62
MR caused by changes of left ventricular structure and function related to ischemia
ischemic MR
63
caused by rupture of a mitral papillary muscle occurring during the acute phase of myocardial infarction, and is associated with high mortality
acute ischemic MR
64
occurs more than 2 weeks after infarction with absence of structural mitral valve disease, and is caused by modifications of geometry and kinetics of the subvalvular apparatus, resulting from abnormalities of regional myocardial contraction
chronic ischemic MR
65
can also occur secondarily as a result of LV failure
MR
66
management of primary MR
surgical repair
67
most common cause of congenital TR
Ebstein anomaly
68
characterized by variable and abnormal developmental anomaly of tricuspid valve including apical displacement of the septal and posterior tricuspid valve leaflets, redundancy and fenestration of the anterior tricuspid leaflet and dilation of the true tricuspid annulus
Ebstein anomaly
69
chambers that dilate in ebstein anomaly
RA and RV, with TR
70
pulmonary vascularity in ebstein anomaly
either normal or decreased
71
cut off of apical displacement of the septal leaflet for Ebstein anomaly
>8mm/m2
72
cyanotic type of CHD characterized by agenesis of the tricuspid valve
tricuspid atresia
73
necessary for survival in TA
obligatory intra-atrial connection through an ASD or patent foramen ovale
74
in TA, RV is typically ___, while RA is
RV is small and hypoplastic, RA is dilated and hypertrophied
75
TA is associated with
right-sided aortic arch and TGA
76
patients with TA without TGA typically have
some degree of PS
77
pulmonary vascularity in TA
decreased pulmonary vascularity and flat or concave MPA
78
depicts fatty or muscular separation of the RA from RV in cardiac CT and MRI
TA
79
rare and is most often congenital or acquired due to RHD. it presents with increased pressure gradient between the RA and RV (?5 mmHg), resulting in venous congestion.
TS
80
RA in TS appears
enlarged
81
refers to dynamic or fixed anatomic obstruction to blood flow from the RV to the pulmonary arterial vasculature
congenital PS
82
levels of obstruction in PS
valvular, subvalvular or supravalvular
83
the pulmonic valve commissures may be partially fused resulting in a narrow central orifice, often leading to postenotic dilation of the MPA
PS
84
In PS, valve leaflets may also be irregular and thickened without commissural fusion, as is the case in the majority of patients with what syndrome
Noonan syndrome
85
occurs due to narrowing of the infundibular or subinfundibular right ventricular outflow tract and is present in individuals with TOF
subvalvular PS
86
rare condition resulting from fibromuscular narrowing of the RVOT with subvalvular RVOT obstruction
Double-chambered RV
87
can result from pulmonic valve obstruction at the level of MPA, at its bifurcation, or more distal branches
supravalvular PS
88
approximately 20% of patients with TOF have associated what type of PS
supravalvular PS
89
PR can develop from
congenital PS or TOF that underwent pulmonary valvuloplasty or surgical repair during infancy of early childhood
90
patients with severe PR may eventually dilate what chamber
RV, develop RV failure
91
MRI is commonly used to measure both severity of PR and measure the severity of dilation of the RV to determine the need for surgical or interventional valve replacement rather than 2d echo due to
pulmonary valve is not readily visualized in 2d echo due to its position behind the sternum
92
refers to an infection of the valve leaflets as well as prosthetic valves
infective endocarditis
93
often appears as an irregular mobile or fixed mass attached to the low-pressure side of a valve due to infection
vegetation formation from infective endocarditis
94
useful in diagnosing IE, assessing severity of disease and following patients undergoing treatment
Echocardiography
95
useful in identifying and characterizing vegetations, valve destruction and perivalvular extension
cardiac CT and MRI
96
often superior in detecting small vegetations and valve perforations
TEE
97
common heart-related manifestation in patients with SLE. Unlike IE, these lesions rarely result in hemodynamically significant valve dysfunction and rarely embolize
Libman-Sacks nonbacterial endocarditis
98
in Libman-Sacks nonbacterial endocarditis, small valve vegetations typically affect the ventricular and atrial sides of m
the ventricular and atrial sides of mitral valve
99
refers to valve fibrosis and scarring caused by an autoimmune reaction to infection with group A streptococci, resulting in valve stenosis and/or regurgitation
rheumatic valve disease
100
most common involved valve in RHD is
mitral valve, followed by aortic, tricuspid and pulmonic valves
101
true or false: in most cases of RHD, mitral valve is involved along with one or more other valves
true
102
in RHD, chronic elevation of LA pressure needed to move blood across the stenotic mitral valve results in
atrial dilation and elevated pulmonary pressure
103
approximately 30 to 40% of symptomatic patients with MS develop
atrial fibrillation
104
frequent occurrence in patients with carcinoid syndrome. approximately 30 to 40% of patients with neuroendocrine tumors (most commonly midgut carcinoids) present with carcinoid syndrome, including episodes of flushing, hypotensionm diarrhea and bronchospasm
carcinoid heart disease
105
important contributing factor in the development of carcinoid heart disease
chronic exposure to excessive circulating serotonin
106
characterized by development of plaque-like, fibrous endocardial thickening involving the heart valves
carcinoid heart disease
107
commonly involved valves in carcinoid heart disease
tricuspid and pulmonic
108
first imaging modality in carcinoid heart disease
TTE
109
imaging features include thickening of valve leaflets/cusps and subvalvular apparatus, retraction and altered motion of the leaflets/cusps and valve regurgitation (ranging from mild to severe)
carcinoid heart disease
110
postoperative complications following valve surgery include
infection, dehiscence and perivalvular leak
111
late complications of valve surgery include
valve regurgitation, IE anastomotic dehiscence, pseudoaneurysm and thromboembolic events
