CCI Valvular Pathology Assessment 2 — Questions and Answers
Question 1: Which Doppler finding is most characteristic of severe mitral stenosis?
- Pressure half-time >220 ms (Correct answer)
- Pressure half-time <100 ms
- E/A ratio <1.0
- Deceleration time >280 ms
Correct answer: Pressure half-time >220 ms
A pressure half-time greater than 220 ms corresponds to a mitral valve area of approximately 1.0 cm² or less, indicating severe mitral stenosis.
Question 2: In a patient with aortic regurgitation, which echocardiographic measurement is most predictive of the need for surgical intervention?
- Left ventricular end-systolic diameter >50 mm (Correct answer)
- Left ventricular end-diastolic diameter >55 mm
- Regurgitant fraction >30%
- Vena contracta width >4 mm
Correct answer: Left ventricular end-systolic diameter >50 mm
An LV end-systolic diameter greater than 50 mm (or indexed >25 mm/m²) is a Class I indication for surgery in asymptomatic severe aortic regurgitation per ACC/AHA guidelines.
Question 3: The continuity equation is used primarily to calculate which valve area?
- Aortic valve area (Correct answer)
- Mitral valve area
- Tricuspid valve area
- Pulmonic valve area
Correct answer: Aortic valve area
The continuity equation (AVA = LVOT area × LVOT VTI / AV VTI) is the standard method for calculating aortic valve area by echocardiography.
Question 4: Which condition is most commonly associated with rheumatic mitral stenosis?
- Commissural fusion with leaflet thickening (Correct answer)
- Isolated annular calcification
- Posterior leaflet prolapse
- Chordal elongation
Correct answer: Commissural fusion with leaflet thickening
Rheumatic disease causes commissural fusion, leaflet thickening, and subvalvular disease, producing the classic 'hockey stick' anterior leaflet deformity.
Question 5: A patient has a peak aortic valve gradient of 52 mmHg with an AVA of 0.9 cm² but an LVEF of 30%. How should this be classified?
- Low-flow, low-gradient severe AS (Correct answer)
- Moderate aortic stenosis
- Pseudosevere aortic stenosis
- High-gradient severe AS
Correct answer: Low-flow, low-gradient severe AS
Reduced stroke volume from low EF produces low gradients despite true severe stenosis, classifying this as low-flow, low-gradient severe AS requiring dobutamine stress echo for confirmation.
Question 6: Which finding on color Doppler distinguishes functional from organic mitral regurgitation?
- Central jet in functional vs. eccentric jet in organic (Correct answer)
- Eccentric jet in functional vs. central jet in organic
- Vena contracta is always wider in functional MR
- Jet area is always larger in organic MR
Correct answer: Central jet in functional vs. eccentric jet in organic
Functional MR produces a central regurgitant jet due to symmetric leaflet tethering, while organic MR from leaflet prolapse typically produces an eccentric jet directed away from the prolapsing leaflet.
Question 7: In tricuspid regurgitation severity assessment, a vena contracta width of >7 mm indicates:
- Severe tricuspid regurgitation (Correct answer)
- Moderate tricuspid regurgitation
- Mild tricuspid regurgitation
- Trace tricuspid regurgitation
Correct answer: Severe tricuspid regurgitation
A vena contracta width greater than 7 mm is a specific marker of severe tricuspid regurgitation by ASE 2017 guideline criteria.
CCI Valvular Pathology Assessment 2
Which Doppler finding is most characteristic of severe mitral stenosis?