CCI Valvular Pathology Assessment 4 — Questions and Answers
Question 1: The Carpentier classification for mitral regurgitation Type II refers to:
- Excessive leaflet motion (prolapse or flail) (Correct answer)
- Restricted leaflet motion in systole and diastole
- Restricted leaflet motion in systole only
- Normal leaflet motion with annular dilation
Correct 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.
Question 2: 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?
- 0.63 cm² (Correct answer)
- 0.80 cm²
- 1.26 cm²
- 1.57 cm²
Correct 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).
Question 3: Which finding on 2D echocardiography is most specific for mitral valve prolapse?
- Billowing of mitral leaflet(s) >2 mm posterior to the annular plane in the parasternal long-axis view (Correct answer)
- Mitral leaflet thickening >5 mm in any view
- Eccentric mitral regurgitation jet on apical 4-chamber view
- E/A ratio reversal on mitral inflow Doppler
Correct 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.
Question 4: Which echocardiographic feature differentiates rheumatic aortic regurgitation from aortic root dilation-related AR?
- Leaflet thickening and restricted motion at the tips versus normal leaflet morphology with diastolic coaptation failure (Correct answer)
- Central regurgitant jet versus eccentric jet
- Holodiastolic flow reversal in the descending aorta in rheumatic versus absence in root dilation
- Shorter pressure half-time in rheumatic AR
Correct 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.
Question 5: In a patient undergoing exercise stress echocardiography for asymptomatic mitral stenosis, which finding at peak exercise warrants intervention?
- Exercise-induced mean mitral gradient >15 mmHg or pulmonary artery systolic pressure >60 mmHg (Correct answer)
- Peak transmitral velocity >2 m/s at rest only
- Failure of heart rate to increase by 10 bpm
- No change in mitral valve area with exercise
Correct 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.
Question 6: Which prosthetic valve type is preferred for a 35-year-old woman who desires future pregnancy and wants to avoid long-term anticoagulation?
- There is no perfect option; mechanical valves require anticoagulation (teratogenic warfarin risk) while bioprosthetic valves degenerate faster in young patients (Correct answer)
- Bioprosthetic valve without any anticoagulation
- Mechanical valve with aspirin alone
- Transcatheter valve-in-valve
Correct 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.
Question 7: Holodiastolic flow reversal in the descending thoracic aorta by pulsed Doppler is most consistent with which severity of aortic regurgitation?
- Severe aortic regurgitation (Correct answer)
- Mild aortic regurgitation
- Moderate aortic regurgitation
- Pulmonary regurgitation
Correct 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.
CCI Valvular Pathology Assessment 4
The Carpentier classification for mitral regurgitation Type II refers to: