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Chap 11 Part 2
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When A wave is higher than E wave= ________ dysfunction
Diastolic Dysfunction (decreased LV compliance)
what are some Surgical options? Name one.
Annuloplasty (flail leaflet), MV replacement, Mitraclip
Name atleast 3 other abnormalities of MV.
Aneurysm, Endocarditis & valve perforation, Cleft MV, Annular dehiscence, radiation damage, drug (phentermine)
What are the 2 Tumors of MV?
1. Myxtoma (rare, non-cancerous, bulky & moves w/ MV). 2, Fibroelastoma (highly mobile, 2-10mm, attached to MV or chords).
Htn and ______ ______ ______ accelerates conditions causing MAC.
chronic renal insufficiendy
MAC and MVP is most commonly seen in ________ leaflet.
Posterior.
What is shown in the image shown?
Mitral Valve Prolapse (MVP), bowing of the valve into LA During ventricular systole. It can be Bi-leaflet or single.
what am I? connective tissue disorder characterized by thickening and elongation if Mitraal leaflets and chordae and dilation mitral annulus.
Myxomatous Degenration. often causes flail leaflet
What is arrow poiting at in the image shown?
Flail Anterior Leaflet.(can result with disrupted MV apparatus, has eccentric jet on the oppsite side of the flail leaflet, TEE confirms precise location)
What is functional MR?
not caused by the valve instead but underlying issues such as, LAE, LVE, DCM, IHD, HOCM (SAM)
Assessing MR severity, values= mild mod severe. (choose one) color flow jet, Regurgitant fraction, Regurgitant Volume, ROA
Color Flow Jet%= <20 , 20-40 , >40 RV(mL)= <30 , 30-59 , >60 RF(cm)= <0.3 , 0.3-0.7 , >0.7 ROA(cm2)= <0.20 , 0.20-0.39 , >0.40
How do you calculate Regurgitant Volume?
RV= SV regurgitant valve - SV competent Valve
Degree of MR / Vena contracta width = mild moderate severe
mild 0-3cm moderate 0.3 - 0.6cm severe >0.6cm
One fact while doing PISA measurement.
Must lower baseline 40 or lower cm/s. Cannot be used on multiple jet. ERO/ROA calculated by PISA. Valve should be completely closed in systole.
True/ False: Larger the Regurgitant Volume, Darker the envelope of MR flow.
True. Density is proportional to the number of blood cells within beam.
Jet area and LA area are measured in A4C. What is the equation for percentage of total LA area?
Jet area/ LAA x100%
What does PISA stand for?
Proximal isovelocity surface area
Name two factors for evaluating severity of MR.
Size of Jet, Volumetric flow by PISA, Effective Regurgitant Orifice, Volume of Regurge flow.
What are some main factors affecting Regurgitant Jet appearance? Name Two.
Gain, Scale, Frame rate, Sector Size, Transducer, Color flow algorithms, Machine
What are changes caused by hemodynamically significant MR. Name Two
LAE, LVE, Elevated LA pressures, pulmonary congestion
True/ False: Overtime, MR causes irreversible reduced LV Myocardial Contractility.
True. MR results in volume overload of LV.
Mitral Regurge is caused by disruption of the Mitral Apparatus. How is MR categorized, explain.
Primary (disease of the MV leaflet), Secondary (Abnormalities of other components of MV apparatus). Treatment is category dependent.
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