Percutaneous Balloon Mitral Valvuloplasty Discussion

Percutaneous Balloon Mitral Valvuloplasty Discussion
Order 59081011
Percutaneous Balloon Mitral Valvuloplasty Discussion
1 Dr. Y has just performed his second inflation across
a congenitally stenotic pulmonary valve using a single balloon technique. The pre- and postprocedural
pressure curves are obtained. The next most appropriate action would be to:
75
50
25
PA
PA
RV
RV
Preprocedure Postprocedure
(A) Conclude that the procedure is a success
(B) Upsize to a larger balloon to improve the valvular
area
(C) Place an intra-aortic balloon pump and call for
emergent pulmonary valve replacement
(D) Perform an emergent TEE to assess whether
there is severe pulmonary regurgitation
(E) Add low dose dobutamine for support given the
drop in the RV pressure
14 A 14-year-old white boy, a member of his high
school basketball team, sees you for consultation
regarding a murmur. He had been followed up for
the murmur by his local pediatric cardiologist but
he has recently moved to your town and he thought
he would check in. He has been feeling fine, except
he notes some increased fatigue lately after an hour
or so of pickup basketball with his friends. He denies
any chest pressure or presyncope. On examination
he has the murmur of aortic stenosis. You obtain
an echocardiogram and his LV function is normal.
The Doppler gradient across his aortic valve reveals a
4.0 m per second maximal velocity and a calculated
valve area of 0.7 cm2. What should be your next
course of action?
(A) He is doing well enough clinically, and he needs
no further studies
(B) He should be referred to an invasive pediatric
cardiologist for consideration of a percutaneous
aortic valvuloplasty procedure
(C) He should undergo a cardiac catheterization
to confirm the aortic stenosis and evaluate his
coronary arteries
(D) He should be started on β-blockers and followed
up with an echocardiogram every 6 months
(E) He should be referred for surgical valve replacement
15 The signs and symptoms of significant MS include
all of the following, except:
(A) Hemoptysis
(B) Pulmonary hypertension
(C) Platypnea-orthodeoxia
(D) Hepatic congestion
(E) Atrial fibrillation with systemic embolism
16 You are asked to see a 25-year-old woman who
is 27 weeks pregnant. She has had little prenatal
care. She has no known heart condition but is
getting progressively short of breath as the pregnancy
continues. She finally saw an internist and obtained
an echocardiogram revealing significant MS with
trivial MR. When you see her, she is clearly in
congestive heart failure but still has normal sinus
rhythm. What is the best option?
(A) Aggressive therapy for her heart failure using
diuretics, angiotensin-converting enzyme (ACE)
inhibitors, β-blockers and digoxin
(B) Put her on complete bed rest until she delivers
the baby
(C) Consult cardiac surgery for mitral valve commissurotomy or replacement now
(D) Consider percutaneous balloon valvuloplasty
now if the valvular anatomy is suitable
(E) Consider abortion of the pregnancy
17 Percutaneous valve replacement or valve repair
procedures are currently under investigation. A
variety of procedures are now in phase I trials or
soon will be. Select the one procedure from the list
below that is not being considered:
(A) A percutaneous mitral valve repair approach
using a clip device to create a double orifice
mitral valve
(B) A percutaneous mitral valve repair approach that
reduces the annular size by placing clips along
the inner surface of the mitral annulus (from a
catheter in the LV guided by one in the coronary
sinus), then pulling the mitral annulus toward a
central clip to reduce the annular size
(C) A percutaneous semilunar valve mounted in a
stent that is derived from the bovine jugular vein
Valvuloplasty and Percutaneous Valve Replacement 237
(D) A percutaneous mitral valve repair approach
using a catheter in the coronary sinus to reduce
the annular size by a cinching method
(E) A percutaneous mitral valve approach to reduce
the mitral annular size by placing epicardial
buttons on either side of the mitral annulus
through a subxiphoid catheter
18 During percutaneous mitral valvuloplasty, the Inoue
balloon initially inflates distally, then the balloon is
pulled into the mitral annulus and inflation to a
maximal balloon diameter is subsequently achieved.
The following images reflect a common problem
encountered during this procedure. What is the
problem that is encountered during this procedure?
A
C D
B
Cathet Cardiovasc Diagn. 1996;37:188–199.
(A) There is submitral scarring that is preventing
the balloon from fully inflating
(B) There is a defect in the distal Inoue balloon that
is preventing full inflation
(C) There is an obstruction in the Inoue catheter
that is preventing full inflation
(D) The operator is using an improper mixture of
radiographic contrast to inflate the balloon
19 Which of the following procedures can routinely
be successfully approached by percutaneous balloon
valvuloplasty techniques?
(A) Calcific mitral valve stenosis (nonrheumatic)
(B) Parachute mitral valve with stenosis
(C) Subaortic membranous stenosis
(D) Cor triatriatum membrane
(E) None of the above
20 Which of the following statements is true regarding
percutaneous balloon mitral valvuloplasty?
(A) It is safe to proceed with mitral valvuloplasty in
the presence of an atrial thrombus if the patient
has been on warfarin for 4 to 6 weeks
(B) The long-term results of surgical commissurotomy for MS are clearly better than those
following balloon valvuloplasty
(C) Asymptomatic patients with MS should undergo balloon valvuloplasty if their MVA is
<1.5 cm2 regardless of whether pulmonary hypertension is present or not
(D) The major factors that have been identified as
predictive of a successful procedure include a
low valvular score and the absence of significant
baseline MR
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