Aortic valve closure is related to an increased pressure in the aorta relative to the left ventricle.
True or False.
True: The left ventricle empties throughout systole, and the change in pressure with ventricular relaxation forces closure or the aortic valve.
The amplitude of aortic root motion has been used to assess:
A. ) The aortic root undulates with motion of the left ventricle.
Findings consistent with aortic stenosis seen on the M-mode echocardiogram include:
B. ) The aortic valve leaflets are thickened. The left ventricular walls are hy0pertrophied, not normal thickness. The size of the left atrium is not affected by the aortic stenosis. The left ventricle has normal, not hypercontractile motion.
The M-mode findings of a young patient with congenital aortic stenosis frequently demonstrate:
A. ) The M mode cannot display doming, which can be seen only on the two-dimensional echocardiogram. The cusps frequently show normal separation and are not thickened or restricted. Diastolic separation of the cusps is seen in aortic regurgitation, not aortic stenosis.
Aortic insufficiency can alter the motion or appearance of the mitral valve by:
A. ) b.) and d.) Shaggy echoes are noted with vegetations depending on the size and position of the jet(s) of aortic insufficiency, the mitral leaflet may flutter. If the volume of aortic insufficiency is such that the left ventricular pressure is increased, decreased separation of the mitral cusps as well as the decrease in the closing velocity can be seen.
Similar spectral patterns can be seen with aortic insufficiency and mitral stenosis. The best way(s) to differentiate the two when both are present is/ are to :
C. ) and c.) Rotating the patient does not necessarily help differentiate the source of the jets. continuous-wave Doppler will show all signals simultaneously and will not distinguish the source. The Intensity of the signal is less in aortic insufficiency than in mitral regurgitation; careful sampling in the left ventricular outflow tract and in the inflow tract should enable the operator to discern the correct source.
The M-mode criterion that is not useful for defining aortic stenosis is:
B. ) Aortic stenosis is defined by abnormal systolic echoes.
The best two-dimensional view used for imaging and calculating the aortic valve orifice is the:
D. ) The parasternal short-axis view best defines the AV orifice, but the reliability of quantitation is debatable.
The best approach for continuous-wave Doppler analysis of aortic stenosis is the:
A. ) The suprasternal view provides the closest and most direct angle to AV outflow.
Overstimation of Doppler peak gradients in aortic stenosis occur with coexistent:
C. ) The aortic flow velocity is increased with coexistent aortic insufficiency which leads to overestimation of the gradient.
The Doppler formula 4x(V2-V2) is important in:
2 1
B. ) and c.) This formula is important in calculating pressure drop when there is an increase in velocity in the left ventricular ouutflow tract and across the aorticf valve, i.e. acorss stenosis and left ventricular outflow obstruction
In patients with aortic stenosis and
In patients with aortic stenosis and low peak velocity due to poor left ventricular function (low flow state), the continuous-wave Doppler waveform should be analyzed for:
A. ) and b.) In patients with critical aortic stenosis but small gradients due to low stroke volume, the continuous-wave Doppler spectrum will demonstrate a later peak and symmetrical confuguration.
High velocity recorded below the baseline on the Doppler spectrum when imaging from the apex by continuous-wave Doppler could be related to:
D. ) c.) and d.) 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:
B. ) Diastolic oscillations may not be associated with aortic steosis.
Bicuspid aortic stenosis is a congenital abnormality.
True or False
True. Sclerotic valves tend to be dense but mobile.
Valve mobility may be the most helpful factor in defining the difference between aortic stenosis and sclerosis:
True or False
True: Sclerotic valvesv tend to be dense but mobile.
Aortic regurgitation can best be defined by the M-mode criterion of:
D. ) Aortic regurgitation jets occur in the left ventricular outflow tract where the anterior leaflet of the mitral valve opens in diastole and the resultant flutter is noted on the Mmode.
One of the first indications of aortic regurgitation noted by two-dimensional echo is:
B. ) Left ventricular size may be expanded owing to the volume of aortic regurgitation.
Aortic regurgitation is best evaluated by Doppler in the:
D. ) This view is used because the angle of incidence is closest to 0 degrees which gives the optimum Doppler angle and the greatest multiplier.
Paradoxical septal motion is most commonly associated with aortic regurgitation.
True or False
False: This is not a finding associated with aortc regurgitation.
Aortic regurgitation may be associated with bacterial endocarditis of the aortic valve.
True or False
True: The bacterial infiltration may lead to poor closure ofr aortic cusps.
Color flow examinations of the aortic valve flow in patients with aortic stenosis should be performed from with view:
E. ) all of the above.: the sonographer should attempt all views, but usually the apical view is the least successful.
The Doppler recording can underestimate aortic stenosis peak velocity if:
B. ) c.) and d.) Underestimation occurs with reduced cardiac output when the maxumum 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:
A. ) The reason for early mitral valve closure in acute aortic insufficiency is elevated left ventricular diastolic pressure. Neither reduced cardiac output nor reduced left ventricular compliance affect mitral valve closure. The regurgitant jet of aortic insufficiency may affect mitral valve opening but will not cause early closure.
The effect of aortic regurgitation on the left ventricle is:
C. ) c.) and d.) Concentric left ventricular hypertrophy is related to aortic stenosis, not insufficiency. The effects of aortic regurgitation are increased septal motion, left ventricular dilatation, and sometimes septal flutter.
The M-mode findings in patients with aortic regurgitation may include:
D. ) and c.) Systolic flutter of the aortic leaflets is a normal finding. Flutter of the interventricular septum caused by aortic insufficiency is a diastolic, not a systolic, phenomenon. Diastolic leaflet flutter and diastolic left ventricular outflow tract echoes are seen with aortic insufficiency.
Reverse doming of the anterior mitral valve leaflet can be observed in:
C. ) The term reverse doming refers to the convex curve sometimes observed on the two-dimensional echo of the mitral valve inthe parasternal long-axis and/or apical view of patients with aortic regurgitation.
Methods used in quantitating the severity of aortic insufficiency are:
D. ) c.) and d.) Traditionally, aortic insufficiency is evaluated by the pulsed mapping technique. With insufficiency, the gradient does not help to determine the severity. A rapid pressure half-time means severe insufficiency. Last, color flow imaging of the thickness at the regurgitant stream at the valve is an accurate way of determining severity.
In combined aortic stenosis and insufficiency, the continuous-wave aortic waveform must be carefully analyzed so that the severity of the aortic stenosis will be correctly assessed. A mild gradient may be expected if:
a.) A high peak velocity is recorded with an early-peaking, asymmetrical, rapidly descending spectrum.
b.) A high peak velocity is recorded with a later-peaking, symmetrical spectrum.
c.) A low peak velocity is recorded with a late-peakin, symmetrical waveform.
d.) a low peak velocity is recorded with early- peaking, asymmetrical waveform.
a,) and d.) The Doppler aortic spectral waveform in significant aortic stenosis is late-peaking and symmetrical. If the aortic stenosis is less severe, the spectral waveform shows early peaking and a rapid descent, becoming asymmetrical. This is important in cases of combined aortic stensosis and insufficiency and also in cases of poor left ventricular function.