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Flashcards in Valvular Heart Disease Deck (42)
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1

What are the echocardiographic indications for surgery in chronic AR?

EF <50%
LVESD >5cm
LVEDD >6.5cm
Rapid progression/deterioration

2

What is the Wilkins Score and what is its use?

Predicts procedural success for mitral valvuloplasty based on valve structure. <8 predicts favourable result.

3

What are the scores used to predict outcomes after valve surgery?

Euroscore 2
STS score

4

At what aortic diameter in a female with marfans or bicuspid Aortic valve would you recommend against pregnancy?

>50mm

5

What is the medical therapy for chronic AR?

ACE/ARB
Beta Blocker

6

What is the progression of moderate AR without concurrent aortic dilation?

Slow

7

What is the use of MSCT in the setting of AS?

Useful to characterise likelihood of severity in the setting of low flow, low gradient AS in patients with HFPEF

8

What are the risk factors post cardiac valve surgery not considered in the ES2 and STS scores?

Porcelain aorta
Frailty
Sequelae of chest radiotherapy

9

In what valve disease does exercise testing provide information on prognosis and management?

Aortic stenosis
Mitral regurgitation

10

What is the Carpentier classification?

Used to characterise mitral valve anatomy in preparation for surgery

11

Describe the types in the carpentier classification.

Type 1 - normal leaflet motion, jet directed centrally
Type 2 - excessive leaflet motion, jet eccentric and directed away from pathological leaflet
Type 3 - restricted leaflet motion
A - restricted in systole and diastole
B - restricted in diastole

12

What are the most common causes of MR based on the Carpentier classification?

Type 1 - secondary MR, endocarditis with perforation
Type 2 - degenerative Disease
Type 3a - rheumatic heart disease
Type 3b - ischaemic MR

13

What are the most common causes of MR?

Degenerative (60-70%)
Functional (25%)
Rheumatic (15%)

14

What are the indications on echocardiography for surgery in the setting of asymptomatic severe primary mitral regurgitation?

EF - <60%
LVESD >45mm
SPAP >50mmhg
(new onset AF)

15

What are the independent predictors of failed mitral valve repair?

Operative - Surgical inexperience
Pathological - Infective endocarditis
Mitral Valve Anatomy - Absence of annular dilation, Mitral stenosis/sclerosis, leaflet calcification, annular calcification

16

What are the benefits of MV repair over replacement?

Reduced peri-operative mortality (ARR 3-4%)
Better 20 year survival (ARR 20%)
Reduced re-operation

17

What is the medical therapy for acute mitral regurgitation?

Diuretics and Nitrates to reduce filling pressures
+/- inotropic agents and IABP

18

When is a patient with severe MR considered to have a low EF and would warrant Href therapy?

<60%

19

In asymptomatic patients with severe primary MR and EF >60% and LVESD 40-45, what are the Echo findings that should make one consider surgery?

Flail leaflet
LA dilatation >60ml/m2 in sinus rhythm

20

What additional investigations can be useful in the assessment of secondary mitral regurgitation when it is unclear if surgery will be of benefit?

Stress echocardiography

21

Why must a TOE be performed prior to mitral valve comissurotomy?

Exclude left atrial thrombus

22

When is it appropriate to utilise stress echocardiography in the setting of MS?

Asymptomatic or symptoms discordant with severity of MS

23

What are the contraindications to mitral valve commisurotomy?

Mitral Valve Area >1.5
Left atrial thrombus
Moderate to severe MR
Severe/bi commissural calcification
Absence of commissural fusion
Concomitant CAD requiring bypass
Severe aortic valve disease/severe TR and TS requiring surgery

24

What is the medical therapy for mitral stenosis?

Diuretics
Beta Blockers
Consider digoxin/calcium channel blockers to control rate

25

What are the echo criteria for significant prosthetic valve degeneration?

Mean Transvalvular gradient - >20mmhg

EOA decrease - >0.6cm2

Doppler velocity index decrease - >0.15

26

In patients with mitral stenosis in sinus rhythm, when would you consider anticoagulation?

Spontaneous echo contrast in LA
LA volume >60ml/m2

27

When would you consider intervention on an asymptomatic patient with mitral stenosis with MVA <1.5?

High thromboembolism risk (previous stroke, LA SEC, new AF)
High risk of haemodynamic decompensation - SPAP >50mmhg, desire for pregnancy, major non cardiac surgery

Need to have favourable clinical and echo characteristics

28

What is the rate of TV bioprosthetic valve dysfunction at 10 years?

42%

29

What types of valve degeneration are seen with porcine and bovine valves?

Bovine - stenosis
Porcine - regurgitation

30

What are the risk factors for structural valve degeneration?

PATIENT
Higher BMI
Lower Age
DISEASE
Smoking
Diabetes
Hyperparathyroidism
Chronic kidney disease
ANATOMY
Prosthesis patient mismatch
Incomplete expansion (Percutaneous valves)