1. Left atrial dilatation is associated with:

    D. ) all of the listed abnormalities can affect the size of the atrium.
  2. The E-F slope of the mitral valve corresponds to which event in the cardiac cycle?

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

    C. ) and d.) The posterior leaflet of the mitral valve is smaller than the anterior leaflet and also scalloped.
  4. Generally, the E-F slope of the mitral valve has been considered to provide a reliable assessment of:

    C. ) and d.) Neither left atrial enlargement nor left atrial 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 stenosis. The rate of the slope will also be affected by changes in left ventricular function.
  5. An increase in the size of the A wave of the mitral valve suggests:

    D. ) and c.) Severe aortic insufficiency increases the left ventricular end-diastolic pressure pressure, thereby diminishing the D-E point separtation and highlighting the atrial component and the A kick.
  6. Normal opening of the mitral valve is caused by the pressures being higher in the left ventricle than in the left atrium.
    True or False
    False: Higher atrial pressures open the mitral valve.
  7. The mitral valve is composed of :

    C. ) b.) and d.) The mitral apparatus is composed of the mitral valve leaflets, chordae tendineae, papillary muscles, and mitral annulus. Fibrous bands can be found in the pericardial space of some patients with pericardial effusions.
  8. The M-mode criterion that defines mitral stenosis the least is :

    B. ) An increased A-C interval suggests increased left ventricular end-diastolic pressure (LVEDP) and possible poor left ventricular function.
  9. The mitral two-dimensional echo view that best allows calculation of the mitral orifice is the:

    B. ) With good imaging, measuring the mitral valve orifice in the parasternal short-axis plane provides reliable results.
  10. Factors that influence the short-axis two-dimensional measurement of the mitral valve are :

    • B. ) and b.) The 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. The color-flow examination of the stenotic mitral valve would typically display:

    C. ) b.) and d.) the color flow depiction of mitral stenosis shows a narrow jet with a blue central core ( aliasied ) surrounded by yellow and red hues. It has been compared to a candle flame.
  12. The mitral two-dimensional echo view that is most used in continuous-wave Doppler imaging of mitral stenosis is the:

    D. ) The apical four-chamber view allows the best angle for evaluating mitral valve flow.
  13. The criterion that is the most helpful in defining mitral stenosis is:

    D. ) Left atrial enlargement is a direct physiological effect of mitral stenosis.
  14. Following a mitral commissurotomy, the valve orifice can be accurately evaluated with the :

    C. ) The surgeon distorts the valve at the time of commissurotomy, and the resultant morphology is not well visualized by two-dimensional echo. M mode has never been optimal for valve orifice determinations, and the bernoulli equation gives velocity information but not orifice size. The most accurate way to determine valve size is with the pressure half-time equation.
  15. Which of the following mitral conditions could couse mitral regurgitation?

    D. ) All may cause improper closure of the valve.
  16. The aortic valve m-mode motion is often abnormal in patients with mitral regurgitation, demonstrating:

    B. ) and c.) 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.
  17. The M-mode findings in mitral regurgitation are:

    D. ) b.) and d.) Flutter of the interventricular septum is seen in aortic insufficiency, not mitral insufficiency. The rest are true: Left ventricular and left atrial enlargement and also flutter of the posterior aortic root may be observed. Pulsations of the right atrial wall may also be observed.
  18. Peak mitral regurgitation velocity tells the examiner:

    C. ) The peak mitral regurgitant velocity tells nothing about the degree of regurgitation, its etiology, or its direction-- only the difference in pressure between the left ventricle and left atrium.
  19. A two-dimensional echo criterion that can be very helpful in determining mitral regurgitation is:

    A. ) Mitral regurgitation causes a reduction in left ventricular outflow, thus reducing the amount of flow through the opening of the valve. The valve closes early.
  20. The two-dimensional echo view best for Doppler analysis of mitral regurgitation is:

    C. ) Usually this is the better Doppler angle in relation to true flow.
  21. Left atrial enlargement could be a criterion for determining mitral regurgitation.
    True or False
    True: Left atrial enlargement is a direct physiological effect of mitral regurgitation.
  22. Mitral regurgitation is always associated with mitral valve prolapse.

    True or False
    False: Mitral regurgitation mahy be caused by a number of mitral valve problems. Mitral prolapse does not guarantee mitral regurgitation.
  23. Which of the mitral conditions listed below could be associated with mitral regurgitation?

    D. ) All could relate to poor valve closure.
  24. The echo/Doppler findings in papillary muscle dysfunction are:

    E. ) all of the above: Each of the conditions described can be found in patients with papillary muscle dysfunction. The dilated mitral annulus may be the cause of the mitral regurgitation; the incomplete mitral closure is due to scarring of the papillary muscles secondary to myocardial infarction. And the papillary muscles shrink, pulling the chordae away from the mitral orifice.
  25. The term myxomatous degeneration used to describe a mitral valve prolapse denotes:

    B. ) The term myxomatous degeneration describes histologic changes seen in the mitral valve by the pathologist. The finging on echocardiography is thickening of the mitral leaflets.
  26. M-mode findings with a flail mitral valve are:

    E. ) All of the above: The listed findings can each be observed with flail mitral valve leaflets.
  27. Doming of the anterior mitral leaflet is seen in:

    a.) Mitral Stenosis
    b.) Redundant, floppy mitral valve.
    c.) Flail mitral leaflet
    d.) Vegetation/ mass involving free edge at the anterior leaflet.
    a.) b.) and d.) The only described instance that does not produce doming is the flail mitral leaflet, which exhibits exaggerated, eccentric motion.
  28. Which set of echocardiographic features best predicts the presence of mitral stenosis in combined mitral stenosis and mitral insufficiency?

    A. ) The two-dimensional parasternal ong-axis view displays the doming of the leaflets in mitral stenosis; the short-axis view may show normal separation of the leaflets. The E-F slope is not a sensitive predictor of mitral stenosis because it is also reduced in other conditions such as reduced left ventricular compliance. Lastly, although thickening of the mitral leaflets in the apical four-chamber view is seen on the mitral stenosis, the doming seen on parasternal long axis is a much better predictor of mitral stenosis.
  29. Mitral annular calcification may obscure the :

    D. ) and c.) 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.
  30. M
  31. Mitral and tricuspid regurgitation are easily differentiated by Doppler because of :

    E. ) All of the above.
  32. The normal brief posterior displacement of the interventricular septum with the onset of diastole (diastolic dip) may be exaggerated in:

    C. ) In mitral stenosis, early diastolic left ventricular filling is restriced, whereas the right ventricle fills rapidly. Therefore the septum bulged toward the lect ventricle in the diastolu.
  33. Common echo-doppler findings in patients with Marfan's syndrome are:

    C. ) b.) and d.) Patients with Marfan's syndrome exhibit a dilated aortic root with aortic regurgitation and mitral valve prolapse. Associated pulmonic regurgitation is not part of the syndrome.
  34. Mitral leaflet motion is influenced by:

    E. ) All of the above
  35. In the M-mode recording of mitral stenosis, the posterior leaflet of the mitral valve moves anteriorly with the anterior leaflet:

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

    D. ) b.) and c.) Patients with aortic valve disease commonly exhibit a reduced E-F slope. This finding is believed to be related to a decreased rate of left ventricular filling associated with reduced left ventricular compliance. Mitral stenosis also exhibits a reduced E-F slope. In dilated cardiomyopathy, early closure of the mitral valve may be seen, but a reduced E-F slope is not.
  37. Two-dimensional determination of the size of a stenotic mitral orifice is optimal only if:

    B. ) b.) and d.) When imaging in the parasternal long-axis, the operator is prevented from adequately visualizing the valve orifice by doming of the anterior mitral leaflet. The parasternal short- axis is the proper position for measuring opening size. The operator must be careful with gain settings and ensure that the scan plane is parallel to and passes directly through the valve orifice.
Card Set
Evaluation of the Mitral Valve