Davies--Evaluation of Mitral Valve

  1. Left atrial enlargement is assoicated with:

    significant mitral regurgitation
    increased pulmonary pressures
    patent ductus arteriosus
    all of the above
    all of above abnormalities can affect the size of the atrium
  2. The E-F slope of the mitral valve corresponds to which cardiac event in the cardiac cycle?

    the "conduit phase"
    rapid diastolic filling
    early systole
    late systole
    rapid diastolic filling

    in a normal anatomy the mitral valve opens in diastole to a low-pressure left ventricle and fills rapidly
  3. True/False:  The posterior leaflet of the MV appears to have a smaller excursion than the anterior leaflet because:

    * it is intersected at an angle that does not show its full size
    * the leaflet never completely opens
    * its excursion is smaller
    * the shape is different than that of the anterior leaflet
    F, F, T, T

    posterior leaflet of the mitral valve is smaller that the anterior leaflet and also scalloped
  4. True/False:  Generally, the E-F slope of the mitral valve has been considered to provided a reliable assessment of:

    left atrial enlargement
    left atrial myxoma
    mitral stenosis
    left ventricular function
    • F, F, T, T
    • neither LA englargement nor LA myxoma is indicated by the E-F slope. The pliability of the leaflets and free motion of the valve give an indication of any valvular stenois. The rate of the slope will also be affected by changes in the left ventricular function
  5. True/False:  An increase in the size of the A wave of the mitral valve suggests.

    left ventricular enlargement
    aortic insufficiency
    an increase in left ventricular end diastolic pressure
    left ventricular hypokinesis
    F, T, T, F

    severe arotic insufficiency increases the left ventricular end-diastolic pressure, thereby diminishing the D-E point separation and highlighting the atrial component and the A kick
  6. True/False:  Normal opening of the mitral valve is caused by the pressure being higher in the left ventricle than the left atrium.

    higher atrial pressures open the mitral valve
  7. True/False:  The mitral valve is composed of

    chordae tendineae
    mitral annuli
    fibrous bands
    papillary muscles
    T, T, F, T
  8. The M-mode criterion that defines mitral stenosis the LEAST is:

    anterior movement of the posterior leaflet
    a reduced E-F slope
    an increased A-C interval
    a dense, thickened appearance of the valve
    an increased A-C interval

    increased A-C suggests increased LVED pressure and possible poor left ventricular function
  9. The mitral 2D echo view that best allows calcualation of the mitral orifice is the:

    Apical 2 chamber
    subcostal 4C
  10. True/False:  Factors that influence the short-axis 2D measurement of the mitral valve are:

    the lateral resolution
    transducer frequency
    axial resolution
    T, T, F, F

    lateral and medial walls appear wider because of lateral resolution. Too high a gain setting will make the orifice too small. Transducer frequency and axial resolution do not affect the measurements
  11. True/False:  The color-flow examination of the stenotic mitral valve would typically display.

    a narrow jet
    central blue jet
    central red jet
    surrounding yellow and red hues
    T, T, F, T

    color flow depiction of mitral stenosis shows a narrow jet with a blue central core(aliased) surrounded by yeloow and red hues.
  12. The criterion that is the most helpful in defining mitral stenosis is:

    left ventricular enlargement
    left atrial enlargement
    left ventricular hypertrophy
    aortic root dilatation
    left atrial enlargement

    left artial enlargement is a direct physiological effect of mitral stenosis
  13. Following a mitral commissurotomy, the valve orifice can be accurately evaluated with the:

    * M-mode, by defining the leaflet separation
    * 2D echo, by imaging the actual orifice
    * Doppler, by the velocity of the flow and Bernoull's equation
    * Doppler, by estimating valve area using the Pressure 1/2 time
    Doppler, by estimating valve area using the Pressure 1/2 time

    M-mode has never been optimal for valve orifice, and the Bernoulli equation gives velocity information but not orifice size. Most accurate way to determine valve size is with P 1/2 time equation
  14. Which of the following mitral conditions could cause mitral regurgitation?

    mitral stenosis
    mitral prolapse
    mitral vegetation
    all of the above
    all of the above
  15. True/False:  The aortic M-mode motion is often abnormal in patients with mitral regurgitation, demonstrating.

    a flutter of the aortic leaflets in systole
    early systolic closure
    gradual closure during systole
    all of the above
    F, T, T, F

    flutter of the aortic leaflets in systole is frequently observed in normal subjects, so it is not considered to be abnormal motion. Early and also gradual systolic closure are frequently seen because of the reduced blood flow.
  16. True/False:  The M-mode findings in mitral regurgitation.

    left ventricular dilatation
    left atrial enlargement
    flutter of the IVS
    flutter of the posterior aortic root
    T, T, F, T

    • flutter of the IVS is seen in arotic insufficiency, not mitral.
    • LV & LA enlargement and also flutter of the posterior aortic root may be observed. Pulsations of the right atrial wall may also be observed
  17. Peak mitral regurgitant velocity tells the examiner:

    * the severity of mitral regurgitation
    * maximum instantaneous pressure difference between the LV & LA
    * cause of the mitral regurgitation
    * direction of the regurgitation jet
    maximum instantaneous pressure difference between the LV & LA

    MR velocity tells nothing about the degree of regurgitation, its etiology, or its direction-only the difference in pressure between the LV and LA
  18. A 2D echo criterion that can be very helpful in determining mitral regurgitation is:

    high frequency oscillations of the mitral valve
    premature closure of the aortic valve
    left ventricular enlargement
    left ventricular hypertrophy
    premature closure of the arotic valve

    MR causes a a reduction in LVOT, thus reducing the amount of flow through the opening of the valve, valve closes early
  19. True/False:  Left atrial enlargement could be a criterion for determining mitral regurgitation.

    left artial enlargement is a direct physiological effect of mitral regurgitation
  20. True/False:  Mitral regurgitation is always associated with mitral valve prolapse.

    mitral regurgitation may be caused by a number of mirtal valve problems. mitral prolapse does not guarantte mitral regurgiation.
  21. True/False:  Which of the mitral conditions listed below could be associated with mitral regurgitation?

    rupture of the chrodae
    flail leaflet
    annular calcification
    all of the above
    All of the above
  22. True/False:  The echo/Doppler finding in papillary muscle dysfuntions are:

    left ventriclar enlargment
    mitral regurgitation
    mitral annulus dilatation
    incomplete mitral valve closure
    All these conditions can be found in patients with papillary muscle dysfunction. dilated mitral annulus may be the cause of MR, the incomplete mitral closure is due to scarring of the papillary muscles secondary to myocardial infarction. And the papillary muscles shiring, pulling the chordae away from the mitral orifice
  23. The term myxomatous degeneration used to describe a mitral valve prolapse denotes:

    thickening of the mitral valve leaflets
    myxoma in the vicinity of the mitral valve
    redundancy of the mitral valve leaflets
    vegetation on the mitral valve leaflets
    thickening of the mitral valve leaflets

    describes histologic changes seen in the mitral valve by the pathologist.
  24. True/False:  M-mode findings with a flail mitral valve are:

    fine systolic flutter of the mitral valve
    coarse, choatic diastolic flutter of the anterior or posterior mitral leaflet
    mitral leaflets noted in the LA during systole
    noncoaptation of the anterior and posterior mitral valve leaflet
    True for all of them
  25. True/False:  Doming of the anterior mitral leaflet is seen in:

    mitral stenosis
    redundant, floppy mitral valve
    flail mitral leaflet
    vegetation/mass involving free edge at the anterior leaflet
    T, T, F, T

    the only described instance that does not produce doming is the flail mitral leaflet, which exhibits exaggerated, eccentric motion
  26. Which set of echo features best predicts the presence of mitral stenosis in combined mitral stenosis and mitral insufficiency?

    separation of the mitral valve leaflets on the PSAX
    doming on the PLAX
    reduced E-F slope on the M-mode
    thickened leaflets, seen on A4 chamber view
    doming on the PLAX
  27. True/False:  Mitral annular calcifications may obscure the:

    anterior mitral valve leaflet
    posterior mitral valve leaflet
    endocardial echoes
    epicardial echoes
    F, T, T, F

    mitral annular calcification can obscure the posterior mitral valve leaflet because of the close proximity of these structures. Because of acoustic shadowing, the posterior left ventricular endocardium may also be obscured
  28. True/False:  Mitral and tricuspid regurgitation are easily differentiated by Doppler because of:

    differences in timing of valve opening and closing
    different locations of the jets
    different directions of the jets
    differences in forward flow velocity curves
    All are True
  29. The normal brief posterior displacement of the IVS with the onset of diastole(diastolic dip) may be exaggerated in:

    mitral insufficiency
    mitral stenosis
    aortic insufficiency
    aortic stenosis
    mitral stenosis

    in mitral stenosis, early diastolic left ventricular filling is restricted, whereas the right ventricle fills rapidly. Therefore the septum bulges toward the left ventricle in early diastole
  30. True/False:  Common echo-Doppler finding in patient with Marfan's syndrome are:

    aortic root dilatation
    mitral valve prolapse
    pulmonary insufficiency
    aortic regurgitation
    T, T, F, T
  31. True/False:  Mitral leaflet motion is influenced by.

    relative pressures in the LA & LV
    velocity and volume of blood flow through the mitral orifice
    left ventricular diastolic compliance
    systolic performance of the LV
    All of them True
  32. In the M-mode recording of mitral stenosis, the posterior leaflet of the mitral valve moves anteriorly with the anterior leaflet:

    80-90% of cases
    30-40% of cases
    80-90% of cases

    posterior leaflet usually moves anteriorly with the anterior leaflet, but if the leaflets are not fused, the posterior leaflet moves posteriorly
  33. True/False:  A reduced E-F slope of the mitral valve on M-mode is seen with:

    arotic valve disease
    reduced left ventricular compliance
    mitral stenosis
    dilated cardiomyopathy
    T, T, T, F
  34. True/False:  2D determination of the size of the stenotic mitral orifice is optimal only if

    viewed in the PSAX
    gain setting are carefully set
    doming of the anterior mitral leaflet is observed
    the scan plane is parallel to and passes directly throught the valve orifice
    T, T, F, T
Card Set
Davies--Evaluation of Mitral Valve