CCI Valvular Pathology Assessment 3

Question 1

Which echocardiographic parameter best reflects the hemodynamic significance of mitral regurgitation?

Accepted Answer

Effective regurgitant orifice area (EROA)

Answer

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?

Accepted Answer

Dynamic left ventricular outflow tract obstruction with associated mitral regurgitation

Answer

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?

Accepted Answer

Suitability of mitral valve for percutaneous balloon mitral valvuloplasty

Answer

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?

Accepted Answer

Syncope with exertion

Answer

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:

Accepted Answer

Preserved ejection fraction with reduced stroke volume index

Answer

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.

CCI - Cardiovascular Credentialing International Practice Test

CCI - Cardiovascular Credentialing International Practice Test

CCI Valvular Pathology Assessment 3