Cardiac Valve Surgery Flashcards

Which finding on intraoperative TEE after mitral valve repair suggests systolic anterior motion (SAM) of the mitral valve?

Answer: Anterior displacement of the anterior mitral leaflet into the LVOT with dynamic obstruction

SAM occurs when a redundant or anteriorly displaced leaflet is drawn into the LVOT during systole by the Venturi effect, causing dynamic outflow obstruction.

The Carpentier functional classification Type I mitral regurgitation is characterized by:

Answer: Normal leaflet motion with annular dilation or leaflet perforation

Carpentier Type I MR involves normal leaflet excursion, with regurgitation caused by annular dilation or leaflet perforation (e.g., from endocarditis).

The primary indication for tricuspid valve repair at the time of left-sided valve surgery is:

Answer: Tricuspid annular dilation greater than 40 mm or moderate-severe functional tricuspid regurgitation

Current guidelines recommend tricuspid repair concomitantly when the tricuspid annulus is ≥40 mm or functional TR is moderate-to-severe at the time of left-sided surgery.

Which valve lesion typically presents with the longest asymptomatic period, delaying the need for surgery?

Answer: Chronic aortic regurgitation

Chronic aortic regurgitation allows the LV to dilate gradually and adapt over years, often remaining asymptomatic despite severe regurgitation until LV dysfunction develops.

What is the most common cause of bioprosthetic valve failure requiring reoperation?

Answer: Structural valve deterioration (calcification and leaflet tears)

Structural valve deterioration due to progressive calcification and leaflet degeneration is the leading cause of bioprosthetic valve failure over time.

After mechanical heart valve replacement, the target INR for a bileaflet mechanical aortic valve in a low-risk patient is:

Answer: 2.0–3.0

Current guidelines recommend an INR of 2.0–3.0 for bileaflet mechanical aortic valves in patients without additional risk factors.