CCI Valvular Pathology Assessment 3 — Questions and Answers
Question 1: Which echocardiographic parameter best reflects the hemodynamic significance of mitral regurgitation?
- Effective regurgitant orifice area (EROA) (Correct answer)
- Color Doppler jet area
- Peak regurgitant velocity
- Pulmonary vein systolic flow reversal alone
Correct answer: Effective regurgitant orifice area (EROA)
EROA quantifies the size of the regurgitant orifice independent of driving pressure, making it the most accurate single parameter for MR severity grading.
Question 2: Systolic anterior motion (SAM) of the mitral valve leaflet in hypertrophic obstructive cardiomyopathy (HOCM) causes which valvular complication?
- Dynamic left ventricular outflow tract obstruction with associated mitral regurgitation (Correct answer)
- Mitral stenosis
- Aortic regurgitation
- Pulmonic stenosis
Correct answer: Dynamic left ventricular outflow tract obstruction with associated mitral regurgitation
SAM pulls the anterior mitral leaflet into the LVOT during systole, creating dynamic obstruction and an associated posteriorly directed MR jet.
Question 3: What is the Wilkins score used to assess?
- Suitability of mitral valve for percutaneous balloon mitral valvuloplasty (Correct answer)
- Severity of aortic stenosis
- Risk of aortic valve repair failure
- Tricuspid regurgitation etiology
Correct answer: Suitability of mitral valve for percutaneous balloon mitral valvuloplasty
The Wilkins score grades mitral leaflet mobility, thickening, calcification, and subvalvular thickening (0–16); a score ≤8 predicts good outcome with percutaneous balloon mitral valvuloplasty.
Question 4: In severe aortic stenosis, which hemodynamic finding indicates the poorest prognosis without intervention?
- Syncope with exertion (Correct answer)
- Asymptomatic with AVA 0.95 cm²
- Peak gradient of 40 mmHg
- Mild concentric LV hypertrophy
Correct answer: Syncope with exertion
The classic triad of symptoms in AS (angina, syncope, heart failure) signals decompensation; exertional syncope carries a mean survival of approximately 3 years without valve replacement.
Question 5: Paradoxical low-flow, low-gradient aortic stenosis differs from classic low-flow, low-gradient AS by having:
- Preserved ejection fraction with reduced stroke volume index (Correct answer)
- Reduced ejection fraction below 50%
- Elevated mean gradient above 40 mmHg
- Normal indexed valve area above 0.85 cm²/m²
Correct answer: Preserved ejection fraction with reduced stroke volume index
Paradoxical LFLG AS features preserved EF (≥50%) but low stroke volume index (<35 mL/m²) due to small, hypertrophied LV with diastolic dysfunction causing low gradients despite true severe stenosis.
Question 6: Which color flow Doppler finding in the hepatic veins indicates severe tricuspid regurgitation?
- Systolic flow reversal in the hepatic veins (Correct answer)
- Blunted systolic hepatic vein flow
- Diastolic dominance in hepatic veins
- Increased E-wave velocity in hepatic veins
Correct answer: Systolic flow reversal in the hepatic veins
Systolic reversal of hepatic venous flow is a specific indicator of severe tricuspid regurgitation, reflecting retrograde transmission of high right atrial pressure into the venous system.
Question 7: In a patient with a bioprosthetic mitral valve, which Doppler finding should raise concern for prosthetic valve stenosis?
- Mean gradient >5–6 mmHg at rest (Correct answer)
- Mean gradient <3 mmHg
- Normal pressure half-time of 60 ms
- Peak E-wave velocity of 1.4 m/s
Correct answer: Mean gradient >5–6 mmHg at rest
A mean gradient exceeding 5–6 mmHg at rest for a mitral bioprosthesis is above the expected normal range and suggests pathologic obstruction requiring further investigation.
CCI Valvular Pathology Assessment 3
Which echocardiographic parameter best reflects the hemodynamic significance of mitral regurgitation?