Flashcards in Valvular Heart Disease Deck (42)
What are the echocardiographic indications for surgery in chronic AR?
What is the Wilkins Score and what is its use?
Predicts procedural success for mitral valvuloplasty based on valve structure. <8 predicts favourable result.
What are the scores used to predict outcomes after valve surgery?
At what aortic diameter in a female with marfans or bicuspid Aortic valve would you recommend against pregnancy?
What is the medical therapy for chronic AR?
What is the progression of moderate AR without concurrent aortic dilation?
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
What are the risk factors post cardiac valve surgery not considered in the ES2 and STS scores?
Sequelae of chest radiotherapy
In what valve disease does exercise testing provide information on prognosis and management?
What is the Carpentier classification?
Used to characterise mitral valve anatomy in preparation for surgery
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
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
What are the most common causes of MR?
What are the indications on echocardiography for surgery in the setting of asymptomatic severe primary mitral regurgitation?
EF - <60%
(new onset AF)
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
What are the benefits of MV repair over replacement?
Reduced peri-operative mortality (ARR 3-4%)
Better 20 year survival (ARR 20%)
What is the medical therapy for acute mitral regurgitation?
Diuretics and Nitrates to reduce filling pressures
+/- inotropic agents and IABP
When is a patient with severe MR considered to have a low EF and would warrant Href therapy?
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?
LA dilatation >60ml/m2 in sinus rhythm
What additional investigations can be useful in the assessment of secondary mitral regurgitation when it is unclear if surgery will be of benefit?
Why must a TOE be performed prior to mitral valve comissurotomy?
Exclude left atrial thrombus
When is it appropriate to utilise stress echocardiography in the setting of MS?
Asymptomatic or symptoms discordant with severity of MS
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
What is the medical therapy for mitral stenosis?
Consider digoxin/calcium channel blockers to control rate
What are the echo criteria for significant prosthetic valve degeneration?
Mean Transvalvular gradient - >20mmhg
EOA decrease - >0.6cm2
Doppler velocity index decrease - >0.15
In patients with mitral stenosis in sinus rhythm, when would you consider anticoagulation?
Spontaneous echo contrast in LA
LA volume >60ml/m2
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
What is the rate of TV bioprosthetic valve dysfunction at 10 years?
What types of valve degeneration are seen with porcine and bovine valves?
Bovine - stenosis
Porcine - regurgitation