Valvuloplasty and Percutaneous Valve Replacement

Valvuloplasty and Percutaneous Valve Replacement
Order 5983192
Valvuloplasty and Percutaneous Valve Replacement
1 Each of the following disorders can cause an elevated
gradient between the pulmonary capillary wedge
pressure (PCW) and the left ventricular diastolic
pressure, except:
(A) Mitral valve stenosis
(B) Primary pulmonary hypertension
(C) Pulmonary veno-occlusive disease
(D) Cor triatriatum
(E) Pulmonary vein stenosis
2 A 60-year-old woman with prior mitral commissurotomy for rheumatic mitral stenosis (MS) is
undergoing percutaneous mitral valvuloplasty. Following an Inoue 28 mm balloon dilation of the mitral
valve, the left atrium (LA) mean pressure rises and
the accompanying pressure tracing is noted. The next
most appropriate course of action is to:
Preprocedure During procedure
EKG
50 50
LA LA
LV
LV
0
V
0
Valvuloplasty and Percutaneous Valve Replacement
(A) Remove the balloon and deem the procedure
a success
(B) Upsize to a larger balloon for further dilation
(C) Place an intra-aortic balloon pump and obtain
urgent surgery consultation if the patient is
unstable
(D) Hemodynamically support with phenylephrine
(E) Re-zero the pressure transducer to ensure its
accuracy
3 Each of the following characteristics is a component
of the Massachusetts General Hospital (MGH)
echocardiographic valve score, except:
(A) Mitral valve area (MVA)
(B) Leaflet mobility
(C) Valvular thickening
(D) Valvular calcification
(E) Subvalvular thickening and fibrosis
4 The following echocardiogram is obtained on a
40-year-old Hispanic woman with a prior history
of rheumatic fever as a child. The echocardiographer
noted mild calcium in the leaflet and commented on
A B
LV
RV
AO
LA
LV
LA
RV
AO
233
234 900 Questions: An Interventional Cardiology Board Review
reduced leaflet mobility. The patient is experiencing
progressive dyspnea with exertion. She is referred for
possible percutaneous mitral valvuloplasty. She has
had atrial fibrillation for 2 years. On the basis of the
echocardiographic findings, you would suggest:
(A) Proceeding with percutaneous mitral valvuloplasty
(B) Increasing her diuretics and see her back in 4 to
5 weeks
(C) Trying to get her back in normal sinus rhythm
by adding amiodarone and attempting direct
current cardioversion
(D) Referring her for surgical valve replacement
(E) Referring her for surgical commissurotomy
5 The indications for percutaneous balloon valvuloplasty on a stenotic rheumatic mitral valve include
all of the following, except:
(A) Progressive dyspnea on exertion
(B) New-onset atrial fibrillation
(C) Progressive increase in pulmonary hypertension
(D) Worsening mitral regurgitation (MR)
(E) Paroxysmal nocturnal dyspnea
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