CVT Echocardiography Techniques 5 — Questions and Answers
Question 1: In three-dimensional echocardiography, which parameter for mitral valve assessment is uniquely provided compared to 2D imaging?
- Pressure half-time
- True anatomic mitral valve area by planimetry without geometric assumptions (Correct answer)
- E/A ratio
- Vena contracta length
Correct answer: True anatomic mitral valve area by planimetry without geometric assumptions
3D echo allows direct planimetry of the mitral orifice in the exact plane of the valve without relying on geometric assumptions required by 2D methods.
Question 2: Which Doppler-derived index estimates right atrial pressure when combined with inferior vena cava size and collapsibility?
- Pulmonary vein D-wave velocity
- Hepatic vein systolic blunting
- Tricuspid regurgitation jet velocity alone
- IVC diameter and respiratory collapse percentage (Correct answer)
Correct answer: IVC diameter and respiratory collapse percentage
ASE guidelines use IVC diameter (≥2.1 cm) and collapsibility (<50% with sniff) to estimate right atrial pressure of 15 mmHg versus ≤5 mmHg.
Question 3: A patient with hypertrophic obstructive cardiomyopathy (HOCM) will most likely show which color Doppler finding in the left ventricular outflow tract?
- Blue laminar flow toward the aortic valve
- Mosaic turbulent flow beginning in mid-systole due to dynamic obstruction (Correct answer)
- Red laminar flow consistent with high-velocity laminar jet
- Absent flow signal in systole
Correct answer: Mosaic turbulent flow beginning in mid-systole due to dynamic obstruction
Dynamic LVOT obstruction in HOCM produces turbulent mosaic color flow that begins in mid-systole when the hypertrophied septum and systolic anterior motion of the mitral valve narrow the outflow tract.
Question 4: Which imaging plane in parasternal short-axis view allows measurement of the aortic valve area by direct planimetry?
- Mitral valve level
- Papillary muscle level
- Aortic valve level (Correct answer)
- Apical level
Correct answer: Aortic valve level
Planimetry of the aortic valve orifice is performed in the parasternal short-axis view at the level of the aortic valve leaflets.
Question 5: What does a deceleration time (DT) of less than 150 ms on mitral inflow Doppler indicate in the clinical context of diastolic dysfunction?
- Normal diastolic relaxation
- Impaired relaxation pattern
- Restrictive filling pattern with elevated filling pressures (Correct answer)
- Pseudonormal filling pattern
Correct answer: Restrictive filling pattern with elevated filling pressures
A shortened deceleration time < 150 ms reflects rapid equalization of LA-LV pressures, characteristic of a restrictive filling pattern indicating severely elevated filling pressures.
Question 6: During a bubble (agitated saline) contrast study, appearance of bubbles in the left heart within 3 cardiac cycles after injection into a peripheral vein is most consistent with which diagnosis?
- Left-to-right intracardiac shunt
- Right-to-left intracardiac shunt such as patent foramen ovale (Correct answer)
- Normal cardiac anatomy
- Pulmonary arteriovenous malformation if bubbles appear after 3–5 cycles
Correct answer: Right-to-left intracardiac shunt such as patent foramen ovale
Bubbles crossing to the left heart within 3 cycles indicate a right-to-left shunt at the atrial level, most commonly a patent foramen ovale.
Question 7: Which echocardiographic criterion is used to define severe tricuspid regurgitation by jet area on color Doppler?
- Regurgitant jet area > 5 cm²
- Regurgitant jet area > 10 cm² or jet reaching the posterior right atrial wall (Correct answer)
- Vena contracta > 3 mm
- EROA > 0.2 cm²
Correct answer: Regurgitant jet area > 10 cm² or jet reaching the posterior right atrial wall
Severe TR by color Doppler is characterized by a large jet area > 10 cm² or a jet that reaches the posterior right atrial wall, indicating significant regurgitant volume.
CVT Echocardiography Techniques 5
In three-dimensional echocardiography, which parameter for mitral valve assessment is uniquely provided compared to 2D imaging?