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CC Jan 2016 Mitral Valve Prolapse

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echoecho's version from 2016-03-01 14:43

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Question Answer
What is the mitral valve?Is a two leaflet structure located behind the left atrium and left ventricle near the circumflex coronary artery, coronary sinus, aortic valve and bundl of His
Define MVP?displacement of any portion of the mitral valve into the left atrium during systole
What is Barlow's syndrome?in younger patients, MVP is frequently associated without excess leaflet tissue
What is the cause of MVP in elderly patients?caused by fibroelastic deficiency without excess tissue
What are the ausculatory findings of MVP?mid-systolic "click" as the valvular tissue is displaced into the left atrium, followed by a mid to late systolic murmur (an example of the murmur may be found at www.wilkes.med.ucla.edu/MVPmain.htm
What is the estimated prevalence of MVP in the US?1-2.5%
True or false? In most patients MVP is an asymptomatic condition that does not cause significant morbidity or affect longevity?true
A number of patients with MVP have other complaints that have been called mitral valve prolapse syndrome although this has not been validated as a real entity with direct causation?dizziness, chest pain, palpitations, dyspraxia, and exercise intolerance
Arrhythmia snare frequently noted with MVP patients, list the types?premature atrial and ventricular beats, supra ventricular tachycardia
Have there been reports of sudden death with MVP?yes
Is there a causal relationship between MVP and these arrhythmias?it is not clear whether there is a relationship
What condition associated with MVP is the factor that increases the risk of arrhythmias?mitral regurgitation
Arrhythmias are more likely with increasing ________ of mitral regurgitation?severity
What percent of patients with MVP progress to severe MVP?5-10%
Despite the above fact, MVP remains the most common cause of chronic MR in what countries?developed
MVP is more common in what gender? What gender are referred to surgery for this condition?women; men
Patients with severe MR suffer from increased volume load on what ventricle?left
Because of the increased volume load on the left ventricle, severe MR can lead to what consequences? left ventricular dilation, left ventricular hypertrophy, left atrial enlargement, atrial fibrillation, pulmonary congestion and pulmonary HTN
What two additional dangerous conditions can occur with severe MR?CVA, endocarditis
What is the mortality rate of patients with MVP with severe MR?6-7%
*** When MVP is suspected, what is needed to assess cardiac rhythms along with what procedure to evaluate the presence and severity of MR, left ventricular function and left ventricular size?EKG; TTE
What two options are recommended for patients in whom the above parameters are not satisfactorily assessed by TTE?cardiac MRI or TEE
Patients with symptoms of what should also be considered to have severe ME from MVP, even though they do not meet the echo parameters?heart failure
List the stage of primary mitral regurgitation?A, B, C, D
Comment on the definition, anatomy, valve hemodynamics and hemodynamics consequences of stage A of primary mitral regurgitation?1) at risk 2) anatomy - mild MVP with normal coaptation; mild valve thickening and leaflet restriction 3) valve hemodynamics - no MR jet or small central jet area. 4) hemodynamics consequences - none
Comment on the definition, anatomy, valve hemodynamics and hemodynamics consequences of stage B of primary mitral regurgitation?1) progressive 2) anatomy - severe MVP with normal coaptation. 3) valve hemodynamics - moderate central jets, resurgitant volume and regurgitant fraction. 4) hemodynamics consequences - mild LA enlargement, normal LV and pulmonary pressure
Comment on the definition, anatomy, valve hemodynamics and hemodynamics consequences of stage C of primary mitral regurgitation ?1) severe without symptoms. 2) severe MVP with loss of coaptation and flail leaflet. 3) valve hemodynamics - larger central jet, regurgitant volume and regurgitant fracture. 4) hemodynamics consequences - moderate or severe LA enlargement, LV enlargement; pulmonary HTN may be present
Comment on the definition, anatomy, valve hemodynamics and hemodynamics consequences of stage D of primary mitral regurgitation?1) severe with symptoms. 2) severe MVP with loss of coaptation or flail leaflet. 3) same as C 4) moderate or severe LA enlargement, LV enlargement; pulmonary HTN present
List the five recommendations made by the 2014 ACC/AHA guidelines for managing puts with valvular disease stages 3 and 4? 1) medical therapy is reasonable for patients with stage D disease and left ejection fraction (LVEF) <60% in whom surgery is not contraindicated. 2) valve surgery is recommended for patients with stage D disease and LVEF >30% 3) surgery may be considered in patients with stage D disease and LVEF < 30%. 4). Surgery is recommended for asymptomatic individuals with stage C disease and evidence of LV dysfunction (e.g. LVEF 30-60%). 5) mitral valve repair is reasonable in stage C patients with preserved LV function (LVEF > 60%) if "the likelihood of a successful and durable repair without MR is > 95% with an expected mortality < 1%
The choice to pursue repair or replacement must take into account what?1) anatomy of the valve (e.g. Valve leaflets involved) 2) hemodynamics function, 3) expertise of the surgeon 4) the frequency with which the institution performs the procedure in question
What type of valve requires lifetime anticoagulation?mechanical valve
What type of valve does not require anticoagulation but have a limited life span?bioprosthetic valve
What two benefits does valve repair have (especially for young patients)?1) functional. 2) survival benefits
Is there any recommendations for routine surveillance echo for asymptomatic patients who have MVP and no MR?no
*** Because MR is a progressive disease, what periodic surveillance is recommended for patients with MVP and MR?TTE
*** In the absence of symptoms, TTE is recommended every ___to ___ years for MVP with mild MR and every ____ to ___ years for moderate MR?1) 3-5 years. 2) 1-2 years
Development of what would warrant earlier investigation?symptoms
Patients with seve MR require more frequent what?monitoring
Does the AHA recommend prophylaxis for spontaneous bacterial endocarditis for patients with MVP undergoing dental procedures?no
*** SUMMARY = Persons with MVP may have a constellation of other symptoms (chest pain, dizziness, palpitations) called what syndrome, although it has not been validated as an entity with direct causation?MVP syndrome
*** SUMMARY = Is MVP with MR a progressive disease?yes
*** SUMMARY = MVP with MR requires ______ periodically?surveillance
*** SUMMARY = Surgery is recommended if is a consideration for patients with symptomatic, severe MVP with regurgitation, depending on the degree of what?left ventricular dysfunction
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