Wk 2 Terry Reynolds *valvular disease Flashcards by Yoshiko Peterson

The normal mitral valve area is:

A. 1 to 3 cm2
B. 3 to 5 cm2
C. 4 to 6 cm2
D. 7 to 9 cm2

C. 4 to 6 cm2

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Failed fusion of the superior and inferior endocardial cushions is associated with all of the following EXCEPT:

A. Partial atrioventricular canal defect
B. Complete atrioventricular canal defect
C. Isolated inlet ventricular septal defect
D. Isolated supracristal ventricular septal defect

D. Isolated supracristal ventricular septal defect

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The control that sets the upper limit to which ultrasound information will be processed and displayed is:

A. Depth
B. Far gain
C. Overall gain
D. Reject

A. Depth

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The preferred transducer frequency for imaging a barrel-chested patient is:

A. 2.5 MHz
B. 3.5 MHz
C. 5.0 MHz
D. 7.0 MHz

A. 2.5 MHz

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A maneuver that results in a decrease in venous return is:

A. Inspiration
B. Squatting
C. Straight leg raising
D. Valsalva

D. Valsalva

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A maneuver that will result in tachycardia and a transient decrease in blood pressure is:

A. Inhalation of amyl nitrate
B. Squatting
C. Standing to supine
D. Straight leg raising

A. Inhalation of amyl nitrate

*Amyl nitrite is related to the nitrate medicines and is used by inhalation to relieve the pain of angina attacks. It works by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload.

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A maneuver that will increase venous return is:

A. Expiration
B. Squatting to standing
C. Straight leg raising
D. Supine to standing

C. Straight leg raising

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The best two-dimensional view for determining mitral valve area is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view
D. Subcostal four-chamber view

C. Parasternal short-axis view

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The gold-standard two-dimensional echocardiographic view for diagnosing mitral valve prolapsed is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view of the mitral valve
D. Subcostal four-chamber

B. Parasternal long-axis view

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Excellent two-dimensional views for imaging the tricuspid valve include all the following EXCEPT:

A. Parasternal long-axis view
B. Parasternal short-axis view of the aortic valve
C. Apical four-chamber view
D. Subcostal four-chamber view

A. Parasternal long-axis view

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The smallest vegetation that transthoracic two-dimensional echocardiography can detect is:

A. 1 mm
B. 2 mm
C. 3 mm
D. 4 mm

C. 3 mm

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The hump or break occasionally seen on the M-mode of the mitral valve between the E and F points is designated:

A. B notch
B. f wave
C. Fo
D. h wave

C. Fo ????

The nadir (the lowest point) of the E wave represents the F point.

B notch - The B bump on mitral valve M-mode echogram is predictive of significant elevation of left ventricular end-diastolic pressure (LVEDP)

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The E-F slope of the M-mode of the anterior mitral valve leaflet reflects the:

A. Opening rate of the anterior mitral valve leaflet
B. Rate of diastolic filling of the left ventricle
C. Rate of left atrial emptying during diastasis
D. Rate of systolic filling of the left ventricle

B. Rate of diastolic filling of the left ventricle

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The E-F slope of the M-mode of the anterior mitral valve leaflet in mitral valve stenosis is:

A. Decreased
B. Increased
C. Notched
D. Unaffected

A. Decreased

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The mitral valve M-mode points that denote the beginning and the end of diastole are:

A. C to D
B. D to C
C. D to E
D. E to F

B. D to C

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The anterior mitral valve leaflet E-F slope is decreased in:

A. Left atrial myxoma
B. Left ventricular volume overload
C. Mitral valve prolapse
D. Mitral valve vegetation

A. Left atrial myxoma

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The pulmonic valve leaflet most commonly recorded by M-mode is the:

A. Anterior
B. Left
C. Septal
D. Right

B. Left

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On M-mode, the abrupt downward motion of the pulmonary valve leaflet following atrial contraction is called the:

A. “a” dip
B. “b” dip
C. “c” dip
D. “d” dip

A. “a” dip

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What is the purpose of the sinuses of Valsalva?

The sinuses sit behind each valve cusp and function as support for the valves in systole and a reservoir of blood for coronary artery flow in diastole

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The best two-dimensional view for determining mitral valve area is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view
D. Subcostal four-chamber view

C. Parasternal short-axis view

*planimetry

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The gold-standard two-dimensional echocardiographic view for diagnosing mitral valve prolapsed is the:

A. Apical four-chamber view
B. Parasternal long-axis view
C. Parasternal short-axis view of the mitral valve
D. Subcostal four-chamber

B. Parasternal long-axis view

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Excellent two-dimensional views for imaging the tricuspid valve include all the following EXCEPT:

A. Parasternal long-axis view
B. Parasternal short-axis view of the aortic valve
C. Apical four-chamber view
D. Subcostal four-chamber view

A. Parasternal long-axis view

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The E-F slope of the M-mode of the anterior mitral valve leaflet reflects the:

B. Rate of diastolic filling of the left ventricle

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The E-F slope of the M-mode of the anterior mitral valve leaflet in mitral valve stenosis is:

A. Decreased
B. Increased
C. Notched
D. Unaffected

A. Decreased

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The mitral valve M-mode points that denote the beginning and the end of diastole are: A. C to D B. D to C C. D to E D. E to F

B. D to C

The pulmonic valve leaflet most commonly recorded by M-mode is the: A. Anterior B. Left C. Septal D. Right

B. Left \*right???

On M-mode, the abrupt downward motion of the pulmonary valve leaflet following atrial contraction is called the: A. "a" dip B. "b" dip C. "c" dip D. "d" dip

A. "a" dip

Maneuvers that will increase the duration and severity of mitral valve prolapsed include all of the following EXCEPT: A. Inhalation of amyl nitrate B. Valsalva maneuver C. Supine to standing D. Squatting

D. Squatting \*note: **squatting** * most murmurs become louder * murmur of _hypertrophic CM_ becomes softer * murmur of **MVP becomes shorten**

Possible complications of chronic mitral regurgitation include all the following EXCEPT: A. Atrial fibrillation B. Congestive heart failure C. Increased risk of sudden death D. Pulmonary hypertension

C. Increased risk of sudden death

Congestive heart failure in a patient with significant mitral regurgitation occurs because of increased pressure in the: A. Left atrium B. Right atrium C. Right ventricle D. Aorta

A. Left atrium

The left atrial cardiac catheterization pressure tracing in a patient with significant mitral regurgitation may demonstrate an increase in the: A. "a" wave B. "v" wave C. "x" wave D. "y" wave

B. "v" wave

Diastolic mitral regurgitation is associated with: A. Flail mitral valve B. Mitral valve prolapse C. Severe aortic insufficiency D. Severe tricuspid regurgitation

C. Severe aortic insufficiency

In patients with mitral regurgitation, cardiac catheterization measurements include all the following EXCEPT: A. Left ventricular systolic/diastolic pressure B. Mitral valve area C. Pulmonary artery pressures D. Pulmonary capillary wedge pressure

B. Mitral valve area

A heart sound associated with significant chronic pure mitral regurgitation is: A. Loud S1 B. Fixed split S2 C. S3 D. S4

C. S3

A cardiac catherization technique used to determine the severity of mitral regurgitation is: A. Cardiac fluoroscopy B. Coronary arteriography C. Left ventriculography D. Supravalvular angiography

C. Left ventriculography

Possible complications of acute, severe mitral regurgitation include: A. Syncope B. Hemoptysis C. Pulmonary edema D. Systemic embolization

C. Pulmonary edema

Possible presenting symptoms of significant chronic mitral regurgitation include: A. Angina pectoris B. Ascites C. Fatigue D. Syncope

C. Fatigue

!!! A common finding associated with a regurgitant murmur in the elderly is: A. Aortic valve stenosis B. Mitral annular calcification C. Mitral valve stenosis D. Mitral valve vegetation

B. Mitral annular calcification

Chronic mitral regurgitation results in all the following EXCEPT: A. Left atrial enlargement B. Left ventricular enlargement C. Left ventricular volume overload pattern D. Mitral annular calcification

D. Mitral annular calcification

Possible etiologies for mitral regurgitation include all the following EXCEPT: A. Mitral annulus calcification B. Mitral valve endocarditis C. Papillary muscle dysfunction D. Pulmonary hypertension

D. Pulmonary hypertension

Possible electrocardiographic findings for patients with significant mitral regurgitation include all the following EXCEPT: A. Left atrial enlargement B. Left ventricular hypertrophy C. Right atrial enlargement D. Right ventricular hypertrophy

C. Right atrial enlargement

In patients with significant mitral regurgitation, the isovolumic relaxation time may be: A. Increased B. Decreased C. Affected by respiration D. Unaffected

B. Decreased \*significant MR decrease preload - less blood to pump - decreased IVRT

The effects of chronic mitral regurgitation on interventricular septal motion include: A. Akinesis B. Dyskinesis C. Hyperkinesis D. Paradoxical motion

C. Hyperkinesis heart needs to work harder to pump the blood out

M-mode findings associated with significant chronic mitral regurgitation include all the following EXCEPT: A. Left atrial enlargement B. Left ventricular enlargement C. Fine diastolic flutter of the mitral valve D. Flying W of the pulmonic valve

C. Fine diastolic flutter of the mitral valve \*M-mode recording through the mitral valve from the parasternal long axis position demonstrating diastolic fluttering of the anterior mitral valve leaflet in a patient with **aortic regurgitation or AFib**

Systolic bowing of the interatrial septum toward the right atrium may be an indication of: A. Atrial septal defect B. Mitral regurgitation C. Tricuspid regurgitation D. Tricuspid stenosis

B. Mitral regurgitation

The effect significant mitral regurgitation has on the pulsed-wave Doppler tracing of the pulmonary veins may be described as: A. S wave increases, D wave decreases B. S wave increases, D wave increases C. S wave decreases, D wave increases D. Unaffected

C. S wave decreases, D wave increases

Possible secondary echocardiographic/Doppler findings in patients with severe chronic mitral regurgitation include all the following EXCEPT: A. Increased mitral valve E velocity B. Increased peak aortic valve velocity C. Increased right ventricular dimension D. Shortened time too peak velocity of the right ventricular outflow tract

The Doppler finding of mitral valve regurgitation in coronary artery disease is most likely due to: A. Flail mitral valve B. Mitral valve prolapsed C. Papillary muscle dysfunction D. Subaortic stenosis

C. Papillary muscle dysfunction

An accepted method for the semi-quantitation of mitral regurgitation with pulsed-wave Doppler is: A. Mapping technique B. Maximum velocity of the mitral regurgitation C. Peak A velocity D. Pressure half-time

A. Mapping technique

An accepted method for determining the severity of mitral regurgitation by continuous-wave Doppler is spectral: A. Length B. Strength C. Velocity D. Width

B. Strength

A color flow Doppler method for semi-quantitating mitral regurgitation is regurgitant jet: A. Area B. Height C. Length D. Turbulence

A. Area

The radius of a mitral regurgitation flow convergence hemisphere is 1.1 cm. The proximal isovelocity surface area (PISA) is: A. 1.21 cm2 B. 3.8 cm2 C. 7.6 cm2 D. 15.2 cm2

C. 7.6 cm2 \*note: Area_pisa = 2 x 3.14 x r_pisa² Area_{pisa = 2 (3.14) (1.1cm)²} Area_{pisa =}7.5988 = 7.6

The proximal isovelocity surface area of a mitral regurgitant jet is 7.6 cm2. The aliasing flow velocity is 24 cm/sec. The time velocity integral (TVI) of the mitral regurgitation jet is 150 cm. The maximum velocity of the mitral regurgitation jet is 580 cm/sec. The mitral regurgitant stroke volume is: A. 24 cc B. 47 cc C. 150 cc D. 580 cc

B. 47 cc Reg Flow = 7.6 cm2 (PISA surface area) x 24 cm/s (V _aliasing) = 182.4 EROA = 182. 4 (Reg Flow) / 580 cm/s (Peak V _regurgitant) = 0.3144… Vol _regurgitant = 0.3144 (EROA) x 150 cm/s (VTI _{regurgitant jet}) = 47.12

The peak mitral reguritant velocity reflects the: A. Direction of the regurgitant jet B. Etiology of the mitral regurgitation C. Maximum pressure difference between the left atrium and the left ventricle D. Severity of the mitral regurgitation

C. Maximum pressure difference between the left atrium and the left ventricle

In patients with significant mitral regurgitation, the continuous-wave Doppler tracing of the regurgitant lesion may demonstrate a(n): A. Asymmetrical shape of the mitral regurgitation flow velocity spectral display B. Jet area of 20% C. Jet duration of less than 85 msec D. Symmetrical shape of the mitral regurgitation flow velocity spectral display

A. Asymmetrical shape of the mitral regurgitation flow velocity spectral display

Cardiac Doppler evidence of severe mitral regurgitation includes all the following EXCEPT: A. Darkly stained continuous-wave Doppler tracing B. Mitral valve E velocity \<1.5 m/sec C. Pulmonary vein systolic flow reversal D. Regurgitant jet area \>8.0 cm2

B. Mitral valve E velocity \<1.5 m/sec

Flail mitral valve can be differentiated from severe mitral valve prolapsed on two-dimensional echocardiography because flail mitral valve leaflet demonstrates: A. A thicker mitral valve B. Chronic mitral regurgitation C. Leaflet tips that point toward the left ventricle D. Leaflet tips that point toward the left atrium

D. Leaflet tips that point toward the left atrium

In patients with severe acute mitral regurgitation, the continuous-wave Doppler maximum velocity of the regurgitant jet is: A. Decreased B. Dependent largely upon left ventricular function C. Increased D. Unaffected

\*\*A. Decreased ## Footnote \*note: With chronic mitral regurgitation, the left atrium hypertrophies and dilates, increasing LA compliance to accommodate volume loading at near-normal pressure. In contrast, acute mitral regurgitation results in pressure and volume loading of a normal, relatively non-compliant atrium.

The most common etiology of mitral valve stenosis is: A. Congenital B. Left atrial myxoma C. Rheumatic fever D. Severe mitral annular calcification

C. Rheumatic fever

The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are: A. Aortic, pulmonic, tricuspid, and mitral B. Mitral, aortic, tricuspid, and pulmonic C. Pulmonic, aortic, tricuspid, and mitral D. Tricuspid, mitral, pulmonic, and aortic

B. Mitral, aortic, tricuspid, and pulmonic

Signs and symptoms of mitral valve stenosis secondary to rheumatic heart disease include: A. Angina pectoris B. Cyanosis C. Pulmonary Hypertension D. Vertigo

C. Pulmonary Hypertension

Auscultatory findings for mitral valve stenosis include all the following EXCEPT: A. Diastolic rumble at the apex B. Loud first heart sound C. Opening snap D. Systolic ejection murmur heard at the base

D. Systolic ejection murmur heard at the base \*MS - blood flows during diastole from LA to LV

A 23-year-old woman complaining of dyspnea presents to the cardiologist. Upon examination, a diastolic rumble and opening snap are heard. The patient remembers having rheumatic fever at the age of 10. Her electrocardiogram demonstrated left atrial enlargement and right ventricular hypertrophy. The diagnosis is: A. Aortic valve stenosis B. Mitral regurgitation C. Rhumatic mitral valve stenosis D. Valvular pulmonic valve stenosis

C. Rhumatic mitral valve stenosis

Patients with mitral valve stenosis, left atrial enlargement, and atrial fibrillation are at increased risk for the development of: A. Left atrial myxoma B. Left atrial thrombus C. Left ventricular dilatation D. Left ventricular thrombus

B. Left atrial thrombus

The valvular disease with which atrial fibrillation is most commonly associated is: A. Acute aortic insufficiency B. Aortic valve stenosis C. Mitral valve prolapse D. Rheumatic mitral valve stenosis

D. Rheumatic mitral valve stenosis

Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral valve stenosis include: A. Aortic insufficiency B. Left atrial myxoma C. Pericardial effusion D. Ventricular septal defect

B. Left atrial myxoma

!!! Auscultatory findings in rheumatic mitral valve stenosis include: A. Austin Flint murmur B. Fixed splitting of S2 C. Loud S1 D. Mid-systolic click

C. Loud S1

Left atrial thrombus is most often associated with: ## Footnote A. Cor triatriatum B. Infective endocarditis C. Mitral valve prolapsed D. Rheumatic mitral valve stenosis

D. Rheumatic mitral valve stenosis \*A left atrial thrombus is most often associated with **atrial fibrillation and/or rheumatic mitral stenosis**.

In pure rheumatic mitral valve stenosis, the left atrium is _______ and the left ventricle is \_\_\_\_\_\_\_. A. Decreased, decreased B. Increased, decreased C. Increased, increased D. Unchanged, increased

C. Increased, increased

The formula used to determine mitral valve area in the cardiac catheterization laboratory is: A. CO ÷ BSA B. CO ÷ MPG C. CO ÷ DFP ÷ 38 x √MPG D. CO ÷SEP ÷44.3 x √MPG

C. CO ÷ DFP ÷ 38 x √MPG

M-mode findings for the mitral valve in patients with rheumatic mitral valve stenosis include all the following EXCEPT: A. Anterior motion of the posterior mitral valve leaflet B. B notch of the anterior mitral valve leaflet C. Decreased E-F slope of the anterior mitral valve leaflet D. Thickened mitral valve leaflets

B. B notch of the anterior mitral valve leaflet *Mitral B bump is essentially* ***a late diastolic phenomenon in which the leaflets keep a semi-open position without LV inflow effectiveness****.* \***_Indicates increased LV end-diastolic pressure (\> 20mmHg)_**

In the M-mode echocardiogram, features of mitral valve stenosis include all the following EXCEPT: A. Anterior motion of the posterior mitral valve leaflets B. Decreased aortic root dimension C. Systolic anterior motion of the mitral valve leaflets D. Left atrial dilatation

C. Systolic anterior motion of the mitral valve leaflets SAM caused by obstructive LVH - increased velocity = lower pressure = anterior leaflet is pulled toward aorta causing aobstruction

In mitral valve stenosis, the posterior mitral valve leaflet on M-mode moves: A. Anteriorly B. Laterally C. Medially D. Posteriorly

A. Anteriorly

Critical mitral valve stenosis is said to be presented if the mitral valve area is reduced to: A. \<1.0 cm2 B. to 1.5 cm2 C. 1.5 to 2.5 cm2 D. 2.5 to 3.5 cm2

A. \<1.0 cm2

Secondary findings in mitral valve stenosis may include: A. Left atrial dilatation and a normal or small left ventricular dimension B. Left atrial dilatation and pulmonary venous stenosis C. Left ventricular and left atrial dilatation D. Left ventricular hypertrophy and left atrial dilatation

A. Left atrial dilatation and a normal or small left ventricular dimension

Typical echocardiographic findings in a patient with isolated rheumatic mitral valve stenosis include all the following EXCEPT: A. D-shaped left ventricle B. Dilated left ventricle C. Left atrial enlargement D. Left atrial thrombus

B. Dilated left ventricle \*In MS, blood volume via MV towrd LV decreases & blood backing up to LA, pulmonary system then right heart

A strong indication for mitral valve stenosis on two-dimensional echocardiography is an anterior mitral valve leaflet that exhibits: A. Coarse, chaotic diastolic motion B. Diastolic doming C. Reverse doming D. Systolic bowing

B. Diastolic doming

Two-dimensional echocardiographic examination reveals thin mobile mitral valve leaflet tips and a Doppler E velocity of 1.8 m/sec with a pressure half-time of 180 msec. The most likely diagnosis is: A. Abnormal relaxation of the left ventricle B. Aortic insufficiency C. Moderate to severe mitral annular calcification D. Rheumatic mitral stenosis

C. Moderate to severe mitral annular calcification

The most accurate method for determining the severity of mitral valve stenosis is: A. Determining the maximum velocity across the mitral valve by pulsed-wave Doppler B. Measuring the E-F slope of the anterior mitral valve leaflet by M-mode C. Measuring the thickness of the mitral valve leaflets D. Performing planimetry of the mitral valve orifice by two-dimensional echocardiograph

D. Performing planimetry of the mitral valve orifice by two-dimensional echocardiograph

Two-dimensional echocardiographic findings for rheumatic mitral stenosis include all the following EXCEPT: A. Hockey -stick appearance of the anterior mitral valve leaflet B. Increased left atrial dimension C. Reverse doming of the anterior mitral valve leaflet D. Thickened mitral valve leaflets and subvalvular apparatus

C. Reverse doming of the anterior mitral valve leaflet

The classic cardiac Doppler features of mitral valve stenosis include all the following EXCEPT: A. Increased E velocity B. Increased mitral valve area C. Increased pressure half-time D. Turbulent flow

B. Increased mitral valve area

The abnormal mitral valve pressure half-time for patients with mitral valve stenosis is: A. 0 to 30 msec B. 30 to 60 msec C. 60 to 90 msec D. 90 to 400 msec

D. 90 to 400 msec

A deceleration time of 800 msec was obtained by pulsed-wave Doppler in a patient with rheumatic mitral valve stenosis. The pressure half-time is: A. 220 msec B. 232 msec C. 400 msec D. 800 msec

B. 232 msec ## Footnote **\*PHT = 0.29 x DT**

A Doppler mean pressure gradient across a stenotic mitral valve of 12 mm HG is obtained. The severity of the mitral stenosis is: A. Mild B. Moderate C. Moderately severe D. Severe

D. Severe \*\*\*C. Moderately severe???

Pulmonary artery banding may result in all the following EXCEPT: ## Footnote **1** Pseudoaneurysm formation **2** Right ventricular hypertrophy **3** Supravalvular pulmonary stenosis **4** Valvular pulmonic stenosis

**4** Valvular pulmonic stenosis \*note: Pulmonary artery banding (PAB) is a palliative surgical technique used for the correction of congenital cardiac defects, characterized by pulmonary over-circulation caused by left-to-right shunting of blood. PAB is reserved for palliation in a certain subset of infants with complex congenital heart disease.[[1]](https://www.ncbi.nlm.nih.gov/books/NBK560838/#) [Level 3] PAB protects pulmonary vasculature by reducing excessive pulmonary blood flow, thereby preventing the onset of irreversible remodeling of the pulmonary vasculature and pulmonary hypertension.

Infective endocarditis is a greater risk in patients with: 1. AFib 2. CAD 3. LV aneurysm 4. prosthetic heart valve

prosthetic heart valve

The mitral valve is considered to be prematurely closed due to severe acute insufficiency when the C point of mitral valve closure occurs: 1. On or before inception of the Q wave 2. Less than 0.05 seconds after the Q wave 3. 0.05 to 0.07 seconds after the Q wave of the electrocardiogram 4. On or before inception of the T wave

1. On or before inception of the Q wave \*Note: _Premature mitral valve (MV) closure_ is a specific and sensitive noninvasive indicator of **acute severe AI.**[³](https://www.coreultrasound.com/uotw-69-answer/#3) Measurement of the mitral valve from a parasternal long axis view with simultaneous ECG tracing allows this measurement to be easily performed. ![]() Mild AI causes the MV to close around 50 msec before the Q wave, while severe AI will result in the mitral valve closing 200 msec or more before the Q wave on the tracing

The usual site of attachment for vegetations on the mitral and tricuspid valves is the: ## Footnote **1** Annulus **2** Atrial side of the valve leaflets **3** Papillary muscles **4** Ventricular side of valve leaflet

**2** Atrial side of the valve leaflets

The vegetation diameter as determined by two-dimensional echocardiography that is most often associated with systemic emboli is: ## Footnote **1** 3 mm **2** 5 mm **3** 7 mm **4** 10 mm

**4** 10 mm

Aortic ring abscess is usually caused by: ## Footnote **1** Infective endocarditis **2** Rheumatic fever **3** Valvular prolapsed **4** Valvular regurgitation

**1** Infective endocarditis

Complications associated with infective endocarditis that may be indications for surgery include all the following EXCEPT: 1. Congestive heart failure 2. Dyspnea 3. Myocardial or annular abscess 4. Recurrent systemic emboli

Dyspnea

Another term for a homograft prosthetic valve is: 1. Allograft 2. Autograft 3. Biograft 4. Heterograf

Allograft

All the following are porcine tissue prosthetic valves EXCEPT: ## Footnote 1. Bjork-Shiley 2. Carpentier-Edwards 3. Hancock 4. Intact

1. Bjork-Shiley \*note: The ***Björk***–***Shiley*** valve is a mechanical artificial heart valve. **Carpentier-Edwards Stentless bioprosthetic valves** are ***made from*** porcine aortic roots The **Hancock** Mitral-Tricuspid is **a porcine tissue valve**, and has a pliable sewing ring. Advantages of having a tissue valve is that one need not take blood-thinner/anticoagulant medication after receiving the valve The Medtronic ***Intact porcine valve*** provides superior results in the aortic position in patients older than 40 years and in the tricuspid position at all ages.

A pulmonic valve relocated to the aortic position is called a(n): ## Footnote **1** Allograft **2** Autograft **3** Heterograft **4** Homograft

**2** Autograft

Coarse fluttering of a tissue prosthetic valve leaflet on M-mode is associated with: **1** Insufficiency **2** Normal function **3** Stenosis **4** Vegetation

**1** Insufficiency

A shortened interval between the aortic second sound (A2) and mitral valve opening recorded for a mitral valve prosthesis may indicate all the following EXCEPT: ## Footnote **1** Perivalvular leak **2** Poor left ventricular function **3** Prolonged PR interval on the electrocardiogram **4** Prosthetic

**3** Prolonged PR interval on the electrocardiogram

Bioprosthetic leaflet degeneration and calcification occurs: ## Footnote **1** Only in adults **2** More frequently in children **3** Equally in children and adults **4** Primarily in women 40 years of age or older

**2** More frequently in children

A prosthetic heart valve is associated with a relatively high rate of outlet strut fracture is: **1** Bjork-Shiley **2** Carpentier-Edwards **3** Ionescu Shiley **4** Starr-Edwards

**1** Bjork-Shiley

An example of a bileaflet tilting disc prosthetic heart valve is: ## Footnote **1** Medtronic-Hall **2** Omniscience **3** St. Jude's **4** Starr-Edwards

**3** St. Jude's

The cardiac Doppler formula that accurately determines the pressure gradient in the prosthetic aortic valve is: ## Footnote **1** 4 x (V 2 2 ) **2** 4 x (V 1 2 - V 2 2 ) **3** 4 x (V 2 2 - V 1 2 ) **4** Area x V 1

**3** 4 x (V 2 2 - V 1 2 )

The best Doppler formula for calculating the effective orifice area (EOA) in a patient with mitral valve replacement is: ## Footnote **1** 4 x (V 2 ) 2 **2** 4 x (V 2 2 - V 1 2 ) **3** (CSA LVOT x TVI LVOT) ÷ TVI MV **4** 220 ÷ pressure half-time

**3** (CSA LVOT x TVI LVOT) ÷ TVI MV \*note: CSA = cross sectional area = 3.14 x r² (it's a continuity equation)

The best Doppler method for evaluating an aortic valve replacement is probably: ## Footnote **1** Deceleration slope **2** Maximum peak instantaneous gradient **3** Pressure half-time **4** Velocity ratio

**4** Velocity ratio ## Footnote The aortic valve velocity ratio (AVVR) is defined as **the peak left ventricular outflow tract (LVOT) Doppler velocity divided by the maximal aortic valve (AV) velocity**.

Doppler evaluation of a prosthetic mitral valve should include all the following EXCEPT: 1. Effective orifice area (continuity equation) 2. Peak A velocity 3. Peak and mean pressure gradients 4. Pressure half-time

Peak A velocity

Diastolic mitral regurgitation is associated with

Severe aortic insufficiency

A regurgitant jet area \<1.0 cm 2 is noted in a prosthetic aortic valve. This can be explained by: A. Ball variance B. Closing volume C. Disc embolization D. Disc occlusion

B. Closing volume

399. A B notch of the mitral valve on M-mode indicates increased left ventricular: A. End-diastolic pressure B. End-systolic pressure C. Mean pressure D. Peak-to-peak pressure

A. End-diastolic pressure

473. As a valve orifice narrows because of stenosis, pressure proximal to the stenosis will: A. Decrease B. Equilibrate C. Increase with inspiration, decrease with expiration D. Increase

D. Increase

479. In patient with aortic valve stenosis, the continuous-wave Doppler recordings demonstrate a maximum systolic velocity across the aortic valve of 5 m/sec. The maximum peak instantaneous pressure gradient is: A. 5 mmHg B. 25 mmHg C. 50 mmHg D. 100 mmHg

D. 100 mmHg pressure gradient = 4V2

481. The formula used to estimate left ventricular end-diastolic pressure (LVEDP) from the continuous-wave Doppler recording of aortic insufficiency is LVEDP is equal to: A. BPs - Vmax AI B. BPd - Vmax AI C. BPd - 4× EDV AI D. BPd - 4× EDV AI^2

D. BPd - 4× EDV AI^2

482. A maximum velocity of 2 m/sec is obtained in a patient with rheumatic mitral valve stenosis: A. 2 mmHg B. 4 mmHg C. 8 mmHg D. 16 mmHg

D. 16 mmHg

483. The time (in milliseconds) for the pressure difference across a valve to fall to one-half of the initial peak pressure difference is known as the: A. Acceleration half-time B. Deceleration half-time C. Pressure half-time D. Velocity half-time

C. Pressure half-time

484. The mitral valve area can be determined by Doppler with the following formula: A. 220 ÷ pressure half-time B. 220 ÷ deceleration time C. Deceleration time ÷pressure half-time D. Pressure half-time ÷ 220

A. 220 ÷ pressure half-time \*note: PHT = 0.29 x DT

485. The Doppler hemodynamic parameters that should be evaluated inpatients with rheumatic mitral stenosis include all the following EXCEPT: A. Mitral valve area B. Pressure half-time C. Pulmonary artery pressure D. Regurgitant fraction

D. Regurgitant fraction

486. The formula that allows for calculation of mitral valve area by Doppler is the: A. Bernoulli equation B. Continuity equation C. Gorlin equation D. Velocity equation

B. Continuity equation

487. A possible pitfall in the pressure half-time (PHT) method of assessing the severity of mitral stenosis is concomitant: A. Aortic insufficiency B. MR C. Pulmonary insufficiency D. TR

A. Aortic insufficiency \*note: Although the PHT technique is easy to use, there are numerous conditions in which the calculated mitral valve area is unreliable and this method should be used with caution. Especially in the following settings: * **Diastolic dysfunction** -can lead to _over estimation_ of MS severity * **Aortic regurgitation** - can lead to _under estimation_ of MS severity * After **valvuloplasty** -- PHT is _unreliable_ * **Heavily calcified valves** - - _unreliable_

488. All the following values increase in patients with mitral valve stenosis during exercise EXCEPT: A. Left ventricular end diastolic pressure B. Pressure half-time C. Systolic pulmonary artery pressure D. Transvalvular pressure gradient

B. Pressure half-time Quantification using the pressure half-time method is based on the assumption that the rate at which the gradient drops during diastole corresponds to the severity of mitral stenosis. The larger the mitral valve orifice area is, the quicker the left ventricle will fill and the more rapidly the gradients will drop. The steeper the curve, the larger is the mitral valve orifice area (and the less severe is mitral stenosis).

489. In patients with significant pure mitral regurgitation, the E velocity of the mitral valve pulsed-wave Doppler tracing is: A. Decreased B. Increased with inspiration C. Increased D. Unaffected

C. Increased \*note: PW DOPPLER MV INFLOW The inflow pattern and velocity can help us identify _supportive_ signs of severe MR! This velocity informs us of the forward stroke volume (SV) across the mitral valve. It can be increased if regurgitation is present. * **_E-Wave Dominant_**_:_ *_supportive_* _sign of severe MR_ * **Increased E Wave (****_\>_****1.2 m/s)** * Increased E/A Ratio * **decreased DT** * Reliable to assess **primary** MR * Challenge for secondary * Unable to differentiate between LV filling pressures or regurgitation * Dominant A-Wave inflow pattern **excludes** severe MR

490. The following two-dimensional and cardiac Doppler information is gathered: the mitral annulus diameter is 4.5 cm, the aortic annulus is 2.0 cm, the mitral time velocity integral is 20 c, and the aortic time velocity integral is 17 cm. The mitral regurgitant fraction is: A. 26.5% B. 31.8% C. 53% D. 83%

D. 83% \*note: **SV** (stroke volume) = **CSA** (cross sectional area: **0.785 x d²** ) **x VTI** SV via MV should be as same as SV via AV MV SV = (0.785 x 4.5²) x 20 _MV SV = 318 mL_ AV SV = (0.785 x 2.0²) x 17 _AV SV = 53.38 mL_ The difference between the volume at MV and AV = _318 mL - 53.38 mL_ = **264.62mL** (regurgitant flow) **Mitral Regurgitant Fraction = 264.62mL / 318mL = 0.83 = 83%** inflow VTI for LVOT & MV inflow \*\*\*_make sure to use_ **_PW_** to place the gate in between the annulus

491. With aortic valve stenosis and significant aortic insufficiency, the severity of the aortic valve stenosis by the Doppler pressure gradient may be: A. Overestimated B. Unaffected C. Underestimated D. Unpredictable

A. Overestimated

492. In patients with aortic valve stenosis, the pressure gradients measured by cardiac Doppler include: A. Maximum peak instantaneous gradient and peak-to-peak gradient B. Maximum peak instantaneous gradient C. Peak-to-mean gradient D. peak-to-peak gradient

B. Maximum peak instantaneous gradient \*note: **cardiac cath** measures the **peak-to-peak gradient** **Doppler** measures the **peak maximum instaneous pressure gradient**

493. 494. The following data is obtained: left ventricular outflow tract diameter is 2.2 cm, left ventricular outflow tract maximum velocity is 1.1 m/sec, and peak aortic velocity is 6 m/sec. The aortic valve area is: A. 0.4 cm^2 B. 0.75cm^2 C. 0.68 cm D. 0.69 cm^2

D. 0.69 cm² \*note: A1V1 = A2V2 solving for A2 = A1V1 / V2 A2 = (0.785 x 2.2²) x (1.1 m/s) / 6 m/s AVA (A2) = 0.69

494. The following data is obtained: left ventricular outflow tract diameter is 2.2 cm, left ventricular outflow tract maximum velocity is 1.1 m/sec, and peak aortic velocity is 6 m/sec. The aortic velocity ratio is: A. 0.18 B. 0.18cm C. 0.18cm^2 D. 0.69cm^2

A. 0.18 \*note: aortic velocity ratio = 1.1 / 6 = 0.18

495. The following data is obtained in a patient with aortic valve stenosis, left ventricular outflow tract diameter is 2.0 cm, and aortic time velocity integral is 40 cm. The aortic valve area is: A. 0.3 cm^2 B. 0.75 cm^2 C. 0.9 cm^2 D. 3.14 cm^2

C. 0.9 cm^2

496. The continuous-wave Doppler maximum aortic insufficiency velocity reflects the: A. Maximum instantaneous systolic pressure gradient between the aorta and the left ventricle B. Maximum peak instantaneous diastolic pressure difference between the aorta and the left ventricle C. Mean diastolic pressure gradient between the aorta and the left ventricle D. Mean systolic pressure gradient between the aorta and the left ventricle

B. Maximum peak instantaneous diastolic pressure difference between the aorta and the left ventricle

497. The regurgitant fraction (RF%)for aortic insufficiency may be calculated by the following pulsed-wave Doppler formula: A. Aortic RF%= mitral SV-aortic SV÷mitral SV B. Aortic RF%=aortic SV-tricuspid SV÷aortic SV C. Aortic RF%=aortic SV-mitral SV÷aortic SV D. RF% is solely a cardiac catheterization technique that cannot be duplicated in the echocardiography lab

C. Aortic RF%=aortic SV-mitral SV÷aortic SV

498. In tricuspid valve stenosis, the Doppler formula used for determining tricuspid valve area (TVA) is: A. Pressure half-time ÷220 B. 190 ÷ pressure half-time C. 220 ÷ deceleration time D. 0.5 ×deceleration time

B. 190 ÷ pressure half-time ???

499. Formulas that may be used to calculate the cross-sectional area of an orifice or vessel through which blood is flowing include all the following EXCEPT: A. 2×π×r² B. π× (D÷2)² C. 0.785 × D² D. π×D²÷4

A. 2×π×r²

The cardinal symptoms of valvular aortic stenosis include all the following EXCEPT: A. Angina pectoris B. Congestive heart failure C. Palpitations D. Syncope

C. Palpitations

Wk 2 Terry Reynolds *valvular disease Flashcards

(129 cards)