All about the Mitral
What causes what?
Tricuspid Time!
Numbers, Numbers, Numbers
Anything Goes...
100
What happens to the mitral valve leaflets during systole with a patient who has MVP
Bows back into the LA during closure.
100
What causes an anterior regurgitation jet?
posterior regurgitation jet?
Posterior leaflet problem
Anterior leaflet problem
100
What is being shown in this clip that could cause regurgitation?
Epstein's Anomaly
100
While evaluating our MR using PISA, we get an answer of 10mm. How would we grade this MR?
Severe.
PISA is severe if it is >or = 10mm or 1 cm
100
In which cardiac cycle does TR and MR occur?
SYSTOLE
200
What is the sequela of events for severe chronic MR?
LA dilation
LV dilation
pulmonary vein reversal
Back up in to the lungs -pulmonary congestion
Pulmonary arteries
Back into right ventricle and continuing through the right heart
200
What causes a flail leaflet of the mitral valve?
When the chordae tendinae that attaches to that leaflet is completely or partially unattached.
200
What does this image represent if it is seen in only diastole? What if we saw it in systole too?
A flattened D shape septum in only diastole indicates volume overload.
If we see it through both cycles, it indicates a pressure overload.
200
We are evaluating MR with color and we estimate that the regurgitation takes up about 25% of the Left atrium, what would we grade the severity based on that color flow jet area?
Moderate
Color Flow Jet Area Moderate = 20-50% of LA
200
What term do we use to describe a regurgitation (volume) problem?
PRELOAD describes a volume overload!
300
What is the specific name for this type of jet?
Which leaflet is problematic? and which direction is the jet?
This is the Coanda Effect, eccentric regurgitation
There is a problem with the anterior leaflet causing a posterior jet
300
What congenital condition do we see on the Mitral Valve? And what could this cause?
Cleft MV. When there is a slit on the leaflet (usually anterior) of the Mitral valve.
Causes MR
300
What is the sequela of events for TR?
Volume overload causes RA and RV enlargement
can back up to IVC
Ascites/Fluid in abdomen
can back up to Iliac Veins B/L
Continuing down to lower extremities
Pulsatile venous flow/Edema
300
While scanning the in the subcostal, we notice our patient IVC measure 2.1 and their IVC is collapsing while breathing. What RA pressure would we add to get our RVSP?
3 mmHg
If IVC is less than or equal to 2.1 and the IVC collapses, we add 3!!
300
What 4 leaflets do we see in Apical 4 chamber?
(For Tricuspid and Mitral)
Tricuspid- Anterior and Septal
Mitral - Anterior and Posterior
ASAP!!!
400
What are key differences in a central Mitral insufficiency jet versus an eccentric insufficiency jet?
A central jet is indicative of LV dysfunction
An eccentric jet suggests a valvular issue
400
What rare condition can cause scarring and stiffness of the Tricuspid valve, creating short fixed leaflets with minimal mobility and producing insufficiency?
And what substance does it secrete?
Carcinoid
Produces seratonin
400
What is the classic Triad for TR?
(occurs in about 40% of patients)
1. Prominent jugular distension (from SVC backup)
2. Pulsatile liver (from IVC backup)
3. Holodiastolic murmur at left sternal border (increasing with inspiration)
400
What are the mild and severe categories for Vena Contracta?
mild is < 0.3
Severe is > or = 0.7
400
What term do we use to describe the process of SAM when the flow is moving so rapidly through the obstructed LVOT, that it pulls up the anterior leaflet of the MV as well.
Venturi Effect
500
What does this waveform imply when we Doppler our Pulmonary Vein?
Severe MR
Flow Reversal
Here's an example of NORMAL Pulmonary vein Doppler
500
What is something that could cause acute MR?
MI or Trauma
Chordal Rupture
Flair Leaflet
Papillary ischemia
Endocarditis
500
While scanning a patient, you CW Doppler their TR max. What information are you wanting from those values and in what equation would you plug it into?
CW Doppler on TR will provide you with the pressure gradient between the Right Atrium and Right Ventricle.
We would plug it into the Bernoulli's equation to get the pressure difference. (△P= 4v^2)
BONUS: What do we add to that to get the RVSP?
3, 8 or 15
500
When calculating our EROA, our answer is 0.42cm2
What would we grade our MR based on that value?
Severe
An EROA over (or equal to) 0.4 is SEVERE
500
What is the difference between grading TR and PHTN?
Grading TR is grading the severity of Tricuspid regurgitation.
Grading PHTN is grading the severity of pressure
(by using CW Doppler on TR max velocity to get a pressure gradient, then add the RA pressure to it to get RVSP)
600
What maneuver could you ask your patient to do to bring out MVP or SAM?
Valsalva
600
What does volume overload from TR cause regarding the IVS?
Paradoxical Septal Motion
IVS moves posterior in diastole
IVS moves anterior in systole
600
Which vessel can we Doppler to confirm severe TR?
Hepatic Veins
600
What is the mild category for a mitral RF%?
<30%
600
What murmur is associated with Barlows?
Mid-systolic Click