Valvular Heart Disease Management Flashcards

A 65-year-old man with bicuspid aortic valve has severe AR with LVEF 55% and LVESD 52 mm but no symptoms. What is the most appropriate management?

Answer: Surgical aortic valve replacement

In severe AR, surgery is indicated when LVESD ≥50 mm (Class IIa) or ≥55 mm (Class I) even in asymptomatic patients to prevent irreversible LV dysfunction.

Which echocardiographic parameter is most useful for determining surgical timing in asymptomatic chronic severe mitral regurgitation?

Answer: Left ventricular end-systolic diameter (LVESD)

LVESD ≥40-45 mm in severe chronic MR is the key echocardiographic threshold that prompts surgical intervention even in asymptomatic patients.

A 70-year-old woman with known moderate aortic stenosis presents with new-onset syncope. Her echo shows AVA 0.85 cm² and mean gradient 48 mmHg. What is the most appropriate next step?

Answer: Aortic valve replacement

Syncope is one of the classic triad of symptoms in severe AS (along with angina and HF), and its onset marks a poor prognosis with ~3-year median survival if untreated—AVR is indicated.

Which of the following is an absolute contraindication to percutaneous mitral balloon commissurotomy (PMBC)?

Answer: Left atrial thrombus

Left atrial thrombus is an absolute contraindication to PMBC because balloon inflation risks thrombus embolization and stroke.

An 80-year-old man with severe AS is deemed high surgical risk (STS score 8%). He has no contraindications to TAVR. What is the recommended approach?

Answer: Transcatheter aortic valve replacement (TAVR)

TAVR is recommended for symptomatic severe AS in patients at high or prohibitive surgical risk (STS ≥8% or institutional agreement on high risk).

Which murmur characteristic distinguishes hypertrophic obstructive cardiomyopathy (HOCM) from valvular aortic stenosis?

Answer: HOCM murmur increases with standing; AS murmur does not

HOCM murmur increases with standing (decreased preload worsens obstruction) and Valsalva, whereas AS murmur decreases with maneuvers that reduce preload.

A patient with a bioprosthetic aortic valve develops structural valve deterioration (SVD) 12 years postoperatively and is now symptomatic. She is a moderate surgical risk (STS 4%). What is the preferred intervention?

Answer: Valve-in-valve TAVR

Valve-in-valve TAVR within a failed bioprosthesis is preferred over redo surgery for patients with moderate-to-high surgical risk and appropriate bioprosthesis anatomy.