Buy Mitral Regurgitation Discussion Assignment

Buy Mitral Regurgitation Discussion Assignment
Buy Mitral Regurgitation Discussion Assignment
1. What is the most common cause of pathologic mitral
regurgitation?
A. Acute ischemic papillary muscle
B. Annular dilation
C. Degenerative mitral valve disease
D. Restricted mitral valve leaets
2. A 76-year-old male undergoes single-vessel coronary
artery bypass grafting with left internal mammary artery
(LIMA) to the left anterior descending coronary artery.
During weaning from bypass, the surgeon called the
echocardiographer to the operating room to review the
TEE before closing the chest. The images in Figure 16.1
and Video 16.1 were acquired. The patient’s preoperative
echo had mild to moderate (2 ) MR with preserved left
ventricular ejection fraction. The surgeon reported all his
vessels have good ow including the new LIMA graft by
Doppler.
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What is the etiology of mitral regurgitation in this patient?
A. Occlusion of the LIMA graft.
B. Stunned myocardium.
C. The preoperative echo was likely misread.
D. Ischemic papillary muscle.
3. What is the etiology of MR in this patient (Fig. 16.2)?
A. Restricted anterior leaet
B. Restricted posterior leaet
C. Prolapse of the anterior leaet
D. Prolapse of the posterior leaet
E. Systolic anterior motion (SAM) of the anterior MV leaet
4. Based on the M-mode image in Figure 16.2, which of the following descriptions would best describe the regurgitant jet?
A. Early systolic posteriorly directed
B. Midsystolic posteriorly directed
C. Late-systolic central jet
D. Late-systolic anteriorly directed
E. Early-systolic anteriorly directed
5. What is the Carpentier classi‘cation for the image in
Figure 16.2?
A. Type I
B. Type II
C. Type IIIa
D. Type IIIb
E. Type IV
6. A 72-year-old female is referred for evaluation of
shortness of breath. Echocardiography reveals mitral
Chapter 16
Mitral Regurgitation
Divya Kapoor and Sasanka Jayasuriya
Figure 16.1
Figure 16.2
00020745 Wolters Kluwer. All Rights Reserved.
114 Section IV Valvular Heart Disease
regurgitation. The following measurements were obtained
with transthoracic echocardiography:
MR continuous-wave Doppler velocity = 5 m/s.
Nyquist Limit scale = 35 cm/s.
Blue to red color-flow Doppler transition = 1 cm.
What is the severity of mitral regurgitation based on the following parameters?
A. Mild (ERO 0.4 cm2
)
E. Cannot be determined with the information provided
7. Which of these patients with severe MR from a type II, P2
etiology would benet most with mitral valve surgery?
A. A 60-year-old asymptomatic male with a left
ventricular ejection fraction (EF) of 65% to 70% and
end-systolic diameter of 3.8 cm.
B. A 68-year-old asymptomatic female with new-onset
atrial brillation and an EF of 65% and end-systolic
diameter of 3.1 cm.
C. A 55-year-old asymptomatic female who runs 3 miles every
day and an EF 55% and end-systolic diameter of 2.8 cm.
D. A 70-year-old asymptomatic male and an EF of 70%
and end-systolic diameter of 2.9 cm.
E. None of these asymptomatic patients have an
indication for MV repair.
8. A 42-year-old male is referred for transesophageal
echocardiography to further evaluate mitral regurgitation.
What is the etiology of MR in this patient, and what is the
anticipated direction of the regurgitant jet (Video 16.2)?
A. Systolic anterior motion (SAM) of the MV leažet with
posteriorly directed MR
B. Flail anterior MV leažet with posteriorly directed MR
C. Anterior mitral valve leažet prolapse with posteriorly
directed MR
D. SAM with anteriorly directed MR
E. Posterior mitral valve leažet prolapse with anteriorly
directed MR
9. The previous patient continues to be symptomatic despite
maximal medical therapy and surgical myectomy are recommended. Based on the information provided, which of the following statements is most accurate concerning this operation?
A. Some surgeons consider intraoperative TEE to be
helpful, but this is not required.
B. The mitral valve will most likely require replacement.
C. Residual SAM and mild MR after surgery will likely
require mitral valve replacement.
D. In most circumstances, the MV apparatus is intact, and
myectomy will resolve MR.
E. An annuloplasty ring is usually all that is required
should the MR persist postmyectomy.
10. A 65-year-old female presented to the emergency department (ED) of a tertiary hospital by ambulance due to
chest pain and acute shortness of breath. The presenting
ECG showed an ST-segment elevation, and the cardiac
catheterization team was paged for emergent angiography. An ED physician was performing an echocardiogram with a handheld ultrasound device when the patient
suffered a brief episode of asystole. A single image
loop was stored in the handheld device (Video 16.3).
Which of the following is the LEAST important step in
management?
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A. Coronary revascularization
B. Pericardiocentesis
C. Intra-aortic balloon pump placement
D. Cardiac surgery following TEE
E. Temporary pacemaker placement
11. Which papillary muscle is most commonly associated
with acute ischemic MR?
A. Anterolateral papillary muscle
B. Anteromedial papillary muscle
C. Posteromedial papillary muscle
D. Posterolateral papillary muscle
E. Inferior papillary muscle
12. A 58-year-old African American male with a history of
hypertension is admitted to the hospital due to dyspnea on
exertion and lower extremity edema. An echocardiogram
is performed on the day of admission and 2 days later.
Spectral Doppler signals of the mitral regurgitant jet from
the two studies are given in Figure 16.3. Assuming that the
CW Doppler cursor alignment and all other echo variables
are consistent between exams, Figure 16.3B was most
likely acquired after which of the following noninvasive
interventions?
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