Davies-Evaluation of Prosthetic Valves

  1. The most common problem associated with prosthetic valve is:

    strut fracture
    improper seating
    clotting problems
    disk fracture
    clotting problems

  2. Quantitation of prosthetic-valve motion is best accomplished by:

    M-mode scanning
    2D scanning
    magnetic resonance imaging
    M-mode scanning

    M-mode allows for direct measurements of prosthetic valve excursion
  3. The Starr-Edwards ball prosthesis has the following orifices:


    primary orifice is composed of the ring the ball sits in, 2nd orifice is between the ring and the ball, the tertiary orifice lies between the ball and the aortic wall
  4. T/F: All prosthetic valves are inherently restrictive. Therefore, when evaluating a prosthetic valve for stenosis, one must take into account not only the velovity of blood flow but also:

    valve size
    patient size
    the age of the valve
    cardiac output

    age of the valve is irrelevant to the doppler hemodymamic evaluation of valvular stenosis. True that bioprosthesis will stiffen with time, but when evaluationg the prosthetic valve for degree of stenosis one considers the size of the valve and the patient for patient prosthesis mismatch as well as cardiac output
  5. T/F: A mechanical prosthesis that reveals incomplete or delayed opening on the M-mode echo suggests.

    deterioration of the valve
    swelling of the valve
    thrombus on the valve
    dehiscence of the valve

    Prosthetic valve motion is impeded when opening is incomplete or delayed. Swelling of old ball material restricts its motion and thrombus formation also restricts motion. Deterioration of the valve material would cause erratic motion, not restriction. Dehiscence of strut also causes erratic motion
  6. T/F: A doppler recording froma  stenotic mitral bioprosthesis might include?

    a rapid diminution in diastolic velocity
    high peak velocity
    slow diminution in diastolic velocity
    turbulent flow

    All stenotic mitral valve demontrate high peak velocity, slow decrease in diastolic velocity, and turbulent flow. A prosthetic valve becomes stenotic functions the same.
  7. T/F:  Higher than normal maximum velocities recorded in a prosthetic valve may be seen with associated.

    Increased LVED pressure
    transprosthetic or paraprosthetic regurgitation
    congestive heart failure
    increased cardiac output

    High prosthetic valve velocities are observed in high flow states such as increased CO and valvular regurgitation. CHF would cause reduced flow and increased LVED pressure but would not affect flow significantly
  8. T/F:  The best approaches for obtaining the highest velocity in an aortic prosthesis is/are from the

    left parasternal veiw
    suprasternal notch
    right sternal border

    There is no one correct position for recording the high velocity of the aortic prosthesis. One must make use of several approaches, that is the apical, suprasternal, and right sternal border. Usually the left parasteranl position isof no value is insonating flow in an aortic prosthesis
  9. T/F:  CW doppler is the doppler technique of choice in measuring transprosthetic blood flow velocities because

    enable the operator to localize the peak velocity
    ensure registration of the peak velocity
    prosthetic valves are often stenotic & produce increased velocity
    it is easier to record the flow velocities with CW doppler

    transprosthetic flow velocities are generally increased b/c prosthetic valves are all somewhat stenotic. To ensure recording of the true peak velocity and to avoid aliasing, it is best to record with the CW techinique. CW do not localize a velocity. 
  10. T/F:  Abnormalities of the bioprosthetic valve seen on echo include.

    excessive rocking motion of valve apparatus
    increased leaflet thickness
    focal mass of echos attached to the valve leaflets
    shadowing of the struts and sewing rings

    it is not abnormal to observe shadowing with any prosthetic valve apparatus. All other abnormalities noted can be observed with bioprostheses
  11. T/F:  Mechanical prosthetic valves include:

    ball in cage
    disk in cage
    tilting cage
    double tilting cage
    All of the above
  12. T/F:  Bioprosthetic leaflet thickening observed on the echo can be associated with

    valvular stenosis
    infectious endocarditis
    normal prosthesis function
    peripheral embolization

    thickening of bioprosthetic leaflets is not a normal observation: it has been observed in valvular stenosis, infectious endocarditis, and peripheral embolization
  13. All three struts of the aortic or mitral bioprosthesis can be seen when imaged from the 

    A4 Chamber
    Subcostal 4C

    only in PSAX can all 3 struts be seen. The struts are oriented 120 degree from each other, so in a plane that passes through the long axis of the valve, only two struts can be seen
  14. Mitral prosthetic valvualar dehiscence is demostrated on echo by?

    valve leaflet echoes appearing in the LA in systole
    rocking, erratic motion of the valve apparatus
    thickened appearance of the valve apparatus
    bright, focal mass on one valve leaflet
    rocking, erratic motion of the valve apparauts

    term dehiscence refers to lack of attachment of a portkion of the prosthetic valve to the heart. The condition produces a rocking, erratic motion on the echo. If valve leaflets appear in the LA in systole, the mitral prosthesis leaflet is flail. Thickened leaflets are associated with stenosis and endocarditis. The focal masses represent endocarditis
  15. Rounding of the E point detected by M-mode in a Bjork-Shiley mechanical prosthesis in the mitral or triscupid position indicates:

    normal function of the valve
    regurgitation of the valve
    obstruction of the valve
    a flail leaflet
    obstruction of the valve

    rounding of the E point on the M-mode of Bjork-Shiley valve is abnormal & indicates some form of obstruction- either thrombosis or tissue ingrowth. It does not indicate regurgitation or a flail leaflet. Bjork-Shiley valve is a tilting disk.
Card Set
Davies-Evaluation of Prosthetic Valves