Valvular Pathology Assessment Flashcards

The Carpentier classification for mitral regurgitation Type II refers to:

Answer: Excessive leaflet motion (prolapse or flail)

Carpentier Type II includes excessive leaflet motion caused by elongated or ruptured chordae tendineae or papillary muscle, producing prolapse or a flail segment.

A patient with aortic stenosis has an LVOT diameter of 2.0 cm, LVOT VTI of 18 cm, and AV VTI of 90 cm. What is the calculated aortic valve area?

Answer: 0.63 cm²

AVA = π×(1.0)²×18/90 = 3.14×0.18 = 0.63 cm², indicating severe aortic stenosis (AVA <1.0 cm²).

Which finding on 2D echocardiography is most specific for mitral valve prolapse?

Answer: Billowing of mitral leaflet(s) >2 mm posterior to the annular plane in the parasternal long-axis view

The diagnostic criterion for MVP is systolic displacement of one or both leaflets ≥2 mm beyond the mitral annular plane in the parasternal long-axis view, which avoids false positives from the saddle-shaped annulus.

Which echocardiographic feature differentiates rheumatic aortic regurgitation from aortic root dilation-related AR?

Answer: Leaflet thickening and restricted motion at the tips versus normal leaflet morphology with diastolic coaptation failure

Rheumatic AR shows thickened, retracted leaflets with restricted motion causing coaptation failure at the tips, while aortic root dilation causes AR by stretching apart otherwise normal leaflets.

In a patient undergoing exercise stress echocardiography for asymptomatic mitral stenosis, which finding at peak exercise warrants intervention?

Answer: Exercise-induced mean mitral gradient >15 mmHg or pulmonary artery systolic pressure >60 mmHg

Exercise-induced mean gradient >15 mmHg or PASP >60 mmHg identifies hemodynamically significant MS even in asymptomatic patients, supporting earlier intervention per ACC/AHA guidelines.

Which prosthetic valve type is preferred for a 35-year-old woman who desires future pregnancy and wants to avoid long-term anticoagulation?

Answer: There is no perfect option; mechanical valves require anticoagulation (teratogenic warfarin risk) while bioprosthetic valves degenerate faster in young patients

Both valve types present challenges: mechanical valves require warfarin (risk of fetal loss/embryopathy) while bioprosthetic valves deteriorate faster in young women, especially during pregnancy, making this a shared decision.

Holodiastolic flow reversal in the descending thoracic aorta by pulsed Doppler is most consistent with which severity of aortic regurgitation?

Answer: Severe aortic regurgitation

Holodiastolic reversal throughout the descending thoracic aorta (EDV/PSV ratio >0.2) reflects a large regurgitant volume returning to the LV throughout diastole, a hallmark of severe AR.