-
True/False: Aortic valve closure is related to an incresed pressure in the aorta relative to the left ventricle.
True
LV empties throughtout systole, and the change in the pressure with ventricular relaxation forces closure of the aortic valve
-
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
-
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
-
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.
-
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
T,T,F,T
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
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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
-
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
-
The best approach for CW Doppler analysis of aortic stenosis is the:
parasternal
apical
suprasternal
subcostal
suprasternal
-
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
-
True/False: The doppler formula  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
-
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
-
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
-
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
-
True/False: Biscuspid aortic stenosis is a congenital abnormality.
True
-
True/False: Valve mobility may be the most helpful factor in defining the difference between arotic stenosis and sclerosis.
True
sclerotic valves tend to be dense but mobile
-
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
-
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
-
Aortic regurgitation is best evaluated by Doppler in the
PLAX
PSAX
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
-
True/False: Paradoxical septal motion is most commonly associated with aortic regurgitation.
False
not assoicated with aortic regurgitation
-
True/False: Aortic regurgitation may be associated with bacterial endocarditis of the aortic valve.
True
bacterial infiltration may lead to poor closure of aortic cusps
-
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
apical
suparsternal notch
All of them True
Sonographer should attempt all views, but usually Apical 4C is the least successful
-
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
-
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
-
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
-
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
-
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
-
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
-
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
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