ITE Valvular Heart Disease Management 2

Question 1

A 68-year-old man with severe aortic stenosis (AVA 0.7 cm², mean gradient 55 mmHg) is asymptomatic with preserved LVEF of 60%. Which management is most appropriate?

Accepted Answer

Watchful waiting with close follow-up every 6-12 months

Answer

Immediate surgical AVR

Answer

Balloon aortic valvuloplasty

Answer

TAVR within 3 months

Question 2

A 55-year-old woman with severe mitral regurgitation has progressive LV enlargement (LVESD 47 mm) but remains asymptomatic with LVEF 60%. What is the next step?

Accepted Answer

Mitral valve repair or replacement

Answer

Continue medical management with ACE inhibitors

Answer

Cardiac resynchronization therapy

Answer

Diuretics and reassess in 6 months

Question 3

Which finding on echocardiography is most consistent with severe mitral stenosis?

Accepted Answer

Mitral valve area of 1.0 cm²

Answer

Mitral valve area of 1.8 cm²

Answer

Mean transmitral gradient of 3 mmHg

Answer

Pressure half-time of 90 ms

Question 4

A 72-year-old with severe symptomatic aortic regurgitation and LVEF of 45% declines surgery. Which medication is most appropriate to reduce afterload?

Accepted Answer

Nifedipine or ACE inhibitor

Answer

Metoprolol

Answer

Digoxin

Answer

Spironolactone

Question 5

A 48-year-old woman with rheumatic mitral stenosis (MVA 1.2 cm²) develops symptomatic dyspnea. Echo shows pliable leaflets, no significant MR, and no left atrial thrombus. What is the preferred intervention?

Accepted Answer

Percutaneous mitral balloon commissurotomy (PMBC)

Answer

Mitral valve replacement with bioprosthesis

Answer

Open surgical commissurotomy

Answer

Medical therapy with diuretics only

Question 6

Which of the following valvular conditions most commonly causes a late-peaking systolic murmur heard best at the right upper sternal border that radiates to the carotids?

Accepted Answer

Aortic stenosis

Answer

Mitral valve prolapse

Answer

Hypertrophic obstructive cardiomyopathy

Answer

Pulmonary stenosis

Question 7

A patient with a mechanical mitral valve prosthesis becomes pregnant. Which anticoagulation strategy is associated with the lowest risk of valve thrombosis?

Accepted Answer

Warfarin throughout pregnancy

Answer

Low-molecular-weight heparin throughout pregnancy

Answer

Aspirin monotherapy throughout pregnancy

Answer

Unfractionated heparin throughout pregnancy