Valves

Question 1

Severe aortic stenosis

Answer 1

AVA < 1 cm2 (mod 1-1.5; mild > 1.5)

Mean gradient > 40 mmHg (mod 25-40)

Velocity > 4 m/second (mod 3-4)

Question 2

Indications for AVR for AS

Answer 2

• Symptomatic AS (Dyspnea, angina, syncope)
• Asymptomatic severe AS with LV dysfunction
• Considered when AVA < 0.6, gradient > 60,

Question 3

Severe Aortic Insufficiency

Answer 3

• Regurgitant fraction >/= 50%
• Vena contracta width (narrowest diameter of the flow stream) > 6 mm
• regurgitant volume >/= 60 mL
• jet width/LVOT > 65%
• effective regurgitant orifice (ERO) area >/= 0.3 cm2

Question 4

Carpentier’s functional classification

Answer 4

Type I: mitral annular dilatation with normal mitral leaflets

Type II: leaflet prolapse or excess motion

Type IIIa: leaflet restriction on systole and diastole from leaflet or chordal retraction or thickening

Type IIIb: leaflet restriction or tethering on diastole from papillary muscle displacement

Question 5

Severe Mitral Regurgitation

Answer 5

• Vena contracta width (narrowest diameter of the jet flow) > 0.7 cm
• ERO > 0.4 cm2
• Regurgitant volume > 60 mL
• regurgitant fraction > 50%
• jet area > 40% of LA area.

Question 6

Indications for MVR for MR

Answer 6

• Symptomatic patients with acute severe MR
• Chronic severe MR and NYHA class II, III, or IV, in the absence of severe LV dysfunction (i.e., EF < 30% and/or end-systolic dimension (ESD) > 55 mm)
• Asymptomatic patients with chronic severe MR and mild-moderate LV dysfunction (EF 30- 60% and/or ESD > 40 mm)
• Asymptomatic patients with chronic severe MR, preserved LV function, and new onset atrial fibrillation or pulmonary hypertension (PA systolic pressure > 50 mmHg at rest or > 60 mmHg with exercise) (Class IIb)

Question 7

Severe Mitral stenosis

Answer 7

• Severe: valve area < 1.0 cm2, gradient > 10 mmHg

- Moderate: valve area 1.0-1.5 cm2, gradient 5-10 mmHg,

Question 8

Indications for MVR for MS

Answer 8

symptomatic patients (NYHA class III-IV) with moderate or severe MS when MBV is unavailable

Question 9

Indications for emergent valve replacement 2/2 endocarditis

Answer 9

• CHF
• prosthetic valve dysfunction
• paravalvular leak
• vegetation > 10mm
• new heart block

Question 10

Indications for AVR for AR

Answer 10

• Symptomatic severe AI
• Asymptomatic severe AI with LV dysfunction
  (EF < 50%)
• asymptomatic with LVEDD approaching 75mm or LVESD approaching 55 mm
• Severe AI undergoing other cardiac procedure
• Acute Onset AI