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Flashcards in Valvular Heart Disease Deck (42)
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31

What are the patient related risk factors for thromboembolism in the setting of mechanical heart valve replacement?

Mitral replacement
Tricuspid replacement
Previous thromboembolism
Atrial fibrillation
Mitral stenosis of any degree
EF <30%

32

What are the potential management options for patients with prosthetic valve obstructive thrombus?

1. Surgery - severe symptoms, mobile veg >3mm or non mobile veg >10mm
2. Fibrinolytics - right sided
3. Anticoagulation - left sided no indication for surgery
3. Palliative care

33

What is the investigative approach to prosthetic valve thrombus?

Transthoracic echo
Transoesophageal echo
4D CT

34

What are the echo criteria for prosthetic valve thrombosis?

BOTH
1. Impaired cusp mobility
2. Cusp thickness >2mm (soft echodensity on echo and hypoattenuation on CT)
- more likely on downstream side of valve
- valve calcification >mild more likely associated with degeneration

35

What are the considerations that alter the management of a patient with obstructive valve thrombosis?

Age and comorbidities
Symptoms
Cause of obstruction
Valve location
Thrombus size
Thrombus mobility

36

What are the factors that favour fibrinolysis for management of obstructive prosthetic valve thrombosis?

High surgical risk
No contraindication to fibrinolysis
First episode valve thrombosis
NYHA1-2
Non mobile clot <1cm
Mobile clot <0.3cm
No other indication for cardiac surgery
Right sided valve involved

37

What are the factors that favour surgical management of obstructive prosthetic valve thrombosis?

Imaging features with concurrent pannus
Low surgical risk
Large or mobile clot
Other indication for cardiac surgery
Contraindication to thrombolytics

38

What are the indications for PMC in a pregnant female with MS and what is the timing?

Valve area <1.5cm2
Symptomatic NYHA3-4
SPAP >50mmhg

Occur after 20 weeks gestation

39

Valve prolapse is more common in which mitral valve? And why?

Posterior leaflet
Lax annulus with less fibrous tissue

40

What is the difference between the primary secondary and tertiary cords?

Primary cords - mitral valve tip attachment
Secondary cords - mitral valve body attachment
Tertiary cords - mitral valve base attachment

41

Which papillary muscle is more prone to ischaemia and prone to contribute to secondary MR?

Posterolateral pap muscle

(Only one artery vs two arteries for anterolateral pap muscle)

42

In the setting of severe AS with functional MR, what tenting area is associated with improvement with Aortic replacement alone?

<2.5cm2