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The most common problem associated with prosthetic valve is:
strut fracture
improper seating
clotting problems
disk fracture
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Quantitation of prosthetic-valve motion is best accomplished by:
M-mode scanning
2D scanning
doppler
magnetic resonance imaging
M-mode scanning
M-mode allows for direct measurements of prosthetic valve excursion
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The Starr-Edwards ball prosthesis has the following orifices:
one
two
three
four
five
three
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
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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
T,T,F,T
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
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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
F,T,T,F
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
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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
F,T,T,T
All stenotic mitral valve demontrate high peak velocity, slow decrease in diastolic velocity, and turbulent flow. A prosthetic valve becomes stenotic functions the same.
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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
F,T,F,T
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
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T/F: The best approaches for obtaining the highest velocity in an aortic prosthesis is/are from the
left parasternal veiw
apex
suprasternal notch
right sternal border
F,T,T,T
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
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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
F,T,T,F
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.
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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
T,T,T,F
it is not abnormal to observe shadowing with any prosthetic valve apparatus. All other abnormalities noted can be observed with bioprostheses
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T/F: Mechanical prosthetic valves include:
ball in cage
disk in cage
tilting cage
double tilting cage
All of the above
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T/F: Bioprosthetic leaflet thickening observed on the echo can be associated with
valvular stenosis
infectious endocarditis
normal prosthesis function
peripheral embolization
T,T,F,T
thickening of bioprosthetic leaflets is not a normal observation: it has been observed in valvular stenosis, infectious endocarditis, and peripheral embolization
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All three struts of the aortic or mitral bioprosthesis can be seen when imaged from the
PLAX
PSAX
A4 Chamber
Subcostal 4C
PSAX
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
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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
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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.
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