Davies--Evaluation of the Aortic Valve

  1. True/False:  Aortic valve closure is related to an incresed pressure in the aorta relative to the left ventricle.

    LV empties throughtout systole, and the change in the pressure with ventricular relaxation forces closure of the aortic valve
  2. The amplitude of aortic root motion has been used to assess:

    the vigor of left ventricular contraction
    the degree of aortic stenosis
    the degree of aortic insufficiency
    the size of the left atrium
    the vigor of left ventricular contraction

    the aortic root undulates with the motion of the left ventricle
  3. True/False:  Findinds consistent with aortic stenosis seen on the M-mode echo include

    normal thickness of the left ventricular wall
    thickened aortic leaflets
    dilated left atrium
    hyperdynamic left ventricular contractility
    F, T, F, T

    leaflets are thickened, LV walls are hypertrophied, LA size not affected, LV has normal not hypercontractile motion
  4. The M-mode finding of a young patient with congenital aortic stenosis frequently demonstrate:

    systolic doming of the cusps
    normal leaflet separation
    thickened, restricted cusps
    diastolic separation of the cusps
    normal leaflet separation

    M-mode can't display doming only on 2D. diastolic separation of cusp is seen in arotic regurgitation, not stenosis.
  5. True/False:  Arotic insufficiency can alter the motion or appearance of the mitral valve by:

    fluttering the leaflets in diastole
    reducing the closing velocity of the mitral leaflets
    producing shaggy echoes around the mitral valve
    decreasing cusp separation

    shaggy echoes are noted with vegetations, depending on the size and position of the jets of aortic insufficiency, the mitral leaflet may flutter. If the volume of the AI is such that the LV pressute is increased, decreased separation of the mitral cusps as well a decrease in the closing velocity can be seen
  6. True/False:  Similar spectral patterns can be seen with aortic insufficiency and mitral stenosis. The best ways to differentiate the two when both are present is/are to.

    be aware that aortic insufficiency will have a less intense signal then mitral stenosis
    rotate the patient more laterally
    use the smallest feasible sample volume and carefully evaluate the area
    use CW doppler from the suprasternal notch
    T, F, T, F
  7. The M-mode criterion that is NOT useful for defining arotic stenosis is:

    dense, thick aortic valve echoes
    a reduced "box" opening
    diastolic aortic valve oscillation
    left ventricular hypertrophy
    diastolic aortic valve oscillation

    aortic stenosis is defined by abnormal systolic echoes
  8. The best approach for CW Doppler analysis of aortic stenosis is the:

  9. Overestimation of Doppler peak gradients in aortic stenosis occur with coexistent:

    aortic insufficiency
    mitral stenosis
    mitral regurgitation
    tricuspid regurgitation
    aortic insufficiency

    aortic flow velocity is increased with coexistent aortic insufficiency which leads to overestimation of the gradient
  10. True/False:  The doppler formula Image Upload 1 is important in:

    aortic stenosis
    mitral regurgitation
    LVOT obstruction
    mitral stenosis
    T, F, T, F

    formula is important in calculating pressure drop when there is an increase in velocity in the LVOT and across the aortic valve, i.e, aortic stenois and LVOT obstruction
  11. True/False:  In patients with arotic stenosis and low peak velocity due to poor left venticular function (low flow state), the CW doppler waveform should be analyzed for

    time to peak velocity
    shape of the spectral waveform
    mean velocity
    intensity of signal
    T, T, F, F

    in patients with critical aortic stenosis, but small gradients due to low stroke volume, the CW doppler spectrum will demostrate a later peak and symmetrical configuration
  12. True/False:  High velocity recorded below the baseline on the doppler spectrum when imaging from the apex of CW doppler could be related to

    aortic stenosis
    aortic regurgitation
    mitral regurgitation
    LVOT obstruction
    T, F, T, T

    • All but aortic regurgitation will produce a high-velocity signal below the baseline when imaged from the apex. Aortic regurgitation will appear as a high-velocity signal above the baseline
  13. The criterion that is NOT helpful for defining aortic stenosis is:

    left ventricular hypertrophy
    arotic postvalvualr dilatation
    left ventricular enlargement
    diastolic oscillations of the aortic cusps
    diastolic oscillations of the aortic cusps

    diastolic oscillations may not be associated wth arotic stenosis
  14. True/False:  Biscuspid aortic stenosis is a congenital abnormality.
  15. True/False:  Valve mobility may be the most helpful factor in defining the difference between arotic stenosis and sclerosis.

    sclerotic valves tend to be dense but mobile
  16. Aortic regurgitation can best be defined by the M-mode criterion of:

    high-frequency oscillations of the aortic valve
    left ventricular hypertrophy
    aortic root dilatation
    high-frequency oscillations of the mitral valve
    high-frequency oscillations of the mitral valve

    aortic regurgitant jets occur in the LVOT where the anterior leaflet of the MV opens in diastole and the resultant flutter is noted on the M-mode
  17. One of the first indications of aortic regurgitation noted by 2D echo is:

    left atrial englargement
    thickened aortic valve
    left ventricular hypertrophy
    left ventricular enlargement
    left ventricular enlargement

    LV size may be expanded owing to the volume of aortic regurgitation
  18. Aortic regurgitation is best evaluated by Doppler in the

    A4 chamber
    subcostal 4 Chamber
    subcostal 4 Chamber

    is used because the angle of incidence is closest to 0 deg which gives the optimum Doppler angle and the greatest multiplier
  19. True/False:  Paradoxical septal motion is most commonly associated with aortic regurgitation.

    not assoicated with aortic regurgitation
  20. True/False:  Aortic regurgitation may be associated with bacterial endocarditis of the aortic valve.

    bacterial infiltration may lead to poor closure of aortic cusps
  21. True/False:  Color flow examinations of the aortic valve flow in patients with aortic stenosis should be performed form which view.

    high right parasternal
    high left parasternal
    suparsternal notch
    All of them True

    Sonographer should attempt all views, but usually Apical 4C is the least successful
  22. True/False:  The doppler recording can underestimate arotic stenosis peak velocity if

    there is a reduced cardiac output
    there is associated aortic regurgitation
    the maximum jet is not recorded
    the angle of incidence is greater than 20 deg
    T, F, T, T

    underestimation occurs with reduced cardiac ouptput when the maximum jet is not recorded and when the angle of incidence is increased
  23. Early closure of the mitral valve in patients with acute aortic insufficiency is due to:

    reduced cardiac output
    regurgitation jet restricting mitral valve motion
    elavated left vetricular diastolic pressure
    reduced left ventricular compliance
    elavated left vetricular diastolic pressure

    reason for early MV closure in acute aortic insufficiency is elevated LV diastolic pressure. Neither reduced CO nor reduced LV compliance affect mitral valve closure. The regurgitation jet of aortic insufficiency may affect mitral valve openining but will not cause early closure
  24. True/False:  The effect of aortic regurgitaion on the left ventricle is

    concentric left ventricular hypertrophy
    increased septal motion
    left ventricular dilatation
    septal flutter
    F, T, T, T

    concentric LV hypertrophy is related to aortic stensosis, not insuffeciency.  The effects of AR are increased septal motion, LV dilatation and sometimes septal flutter
  25. True/False:  The M-mode findings in patients with arotic regurgitation may include.

    fine systolic flutter of the aortic cusps
    fine diastolic flutter of the aortic cusps
    diastolic echoes in the LVOT
    systolic flutter of the IVS
    F, T, T, F

    systolic flutter of the aortic leaflet is a normal finding. Flutter of the IVS caused by AI is diastolic, not systolic phenomenon. Diastolic leaflet flutter and distolic LVOT echoes are seen with aortic insufficiency
  26. Reverse doming of the anterior mitral valve leaflet can be observed in

    idiopathic hypertrophic subaortic stenosis
    aortic stenosis
    aortic regurgitation
    mitral regurgitation
    aortic regurgitation

    reverse doming refers to the convex curve sometimes observed on the 2D echo of the mitral valve in the PLAX or Apical veiw of patients with AR
  27. True/False:  Methods used in quantitating the severity of aortic insufficiency are:

    mapping the flow disturbance with a PW system
    taking the peak velocity of regurgitation, using CW, Doppler, and putting it into the modified Bernoulli equation
    calculating the pressure 1/2 time from CW
    using color flow imaging to evalute thickness of the regurgitant stream as its origin
    T, F, T, T

    aortic insufficiency is evaluated by the pulsed mapping technique. With insufficiency the gradient does not help to determine the severity. Rapid pressure 1/2 time means severe insufficiency. Last color flow imaging of the thickness at the regurgitation stream at the valve is an accurate way of determining severity
  28. True/False:  In combined aortic stenosis and arotic insufficiency, the CW aortic waveform must be carefully analyzed so that the severity of the aortic stenosis will be correctly assessed. A mild gradient maybe expected if

    * high peak velocity is recorded with an early-peaking, asymmetrical rapidly descending spectrum
    * high peak velocity is recorded with a later-peaking, symmetrical spectrum
    * low peak velocity is recorded with a late-peaking symmetrical waveform
    * low peak velocity is recorded with early-peaking, asymmetrical waveform
    T, F, F, T

    doppler in aortic spectral waveform in significant AS is late-peaking and symmetrical. If AS is less severe, the waveform shows early peaking and rapid descent, becoming asymmetrical.  This is important is cases of combined AS & AI and also in poor LV function
Card Set
Davies--Evaluation of the Aortic Valve