Davies--Evaluation of the Tricuspid Valve

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Vaishali71
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166443
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Davies--Evaluation of the Tricuspid Valve
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2012-10-07 13:32:12
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  1. True/False:  Tricuspid valve hemodynamics occur approximately 50 milliseconds prior to mitral valve hemodynamics.
    True
  2. True/False:  The M-mode criteria for tricuspid stenosis includes the following

    dense, thick leaflets
    reduced E-F slope
    reduced A wave
    increased E wave
    T, T, T, F

    M-mode criteria of TS are similiar to the pattern seen in MS
  3. True/False:  The 2D echo views that allow visualization of at least two tricuspid leaflets include

    PLAX (right heart)
    PSAX
    Apical 4c
    Apical
    All True
  4. Which condition is most indicative of tricuspid stenosis?

    right ventricular enlargement
    right venticular hypertrophy
    right atrial enlargement
    pulmonary insufficiency
    right atrial enlargement

    right atrial enlargement is direct physiological consequence of tricuspid stenosis
  5. Which tricuspid M-mode criterion clearly indicates tricuspid regurgitation?

    reduced E-F slope
    mid to late prolapse
    notching
    none of the above
    None of the criteria are directly related
  6. Which of the following 2D echo criteria may be most useful in defining tricuspid regurgitation?

    reduced tricuspid E-F slope
    right ventricular enlargement
    right ventricular hypertrophy
    right atrial enlargement
    right atrial enlargement

    right atrial enlargement is a direct physiological consequence of tricuspid regurgitation, as it is of tricuspid stenosis
  7. Bacterial endocarditis most commonly occurs in the

    mitral valve
    tricuspid valve
    aortic valve
    pulmonic valve
    tricuspid valve

    is the first valve contacted by returning blood flow to the heart and is therefore the valve where bacterial endocarditis most commonly occurs
  8. True/False:  Echo features of carcinoid heart disease involving the tricuspid valve are:

    tricuspid regurgitation
    tricuspid prolapse
    thickened, immobile leaflets
    increased pressure 1/2 time
    T, F, T, F  

    echo features of carcinoid heart disease in the tricuspid valve are thickening, rigid leaflets that do not close during systole, leaving wide-open tricuspid regurgitation
  9. True/False:  When performing a Doppler examination of the IVC and/or hepatic veins for evidence of tricuspid regurgitation, one would expect to find.

    flow toward the transducer in systole
    flow away from the transducer in systole
    flow towards the transducer in diastole
    flow away from the transducer in systole
    T, F, F, T

    subcostal position, presence of flow toward the transducer in systole when flow in the IVC/hepatic vein is being insonated is evidence for tricuspid regurgitation. Normal flow is always away from the transducer in diastole, with or without TR
  10. Tricuspid regurgitation can be recognized on an M-mode study of the IVC in which contrast medium is injected into an arm vein by the appearance of contrast medium:

    following atrial systole
    during ventricular systole
    following atrial diastole
    during ventricular diastole
    during ventricular systole

    contrast appears in the IVC on the M-mode during ventricular systole with TR. It appears following atrial systole in normal subjects and there is no contrast effect in diastole
  11. True/False:  Tricuspid inflow velocity normally resembles mitral flow EXCEPT:

    tricuspid flow is at a higher velocity
    tricuspid inflow is at a lower velocity
    tricuspid inflow increases with inspiration
    tricuspid inflow decreases with inspiration
    F, T, T, F

    mitral valve inflow velocity is normal subjects is higher than tricuspid valve inflow velocity. Also tricuspid inflow increases with inspiration
  12. True/False:  Significant tricuspid regurgitation is present on the Doppler 2D exam when.

    localized tricuspid regurgitation signals are noted
    right atrial dimensions is increased
    systolic flow into the hepatic veins is observed in the subcostal approach
    tricuspid regurgitation jet jugs the interatrial septum
    F, T, T, F

    localized signals means mild TR. RA dimensions are increased in significant insufficiency. When doppler shows systolic flow into the hepatic veins, TR is siginificant. TR jets frequently hug the IAS, and this is not a sign of severity
  13. True/False: Doppler features of tricuspid stenosis include:

    an increase in peak velocity
    slow rate of descent of the velocity curve following peak velocity
    a decrease in velocity with inspiration
    diastolic dispersion
    T, T, F, T

    velocity increase with inspiration in TS. Other answers are all typical of TS-increase in velocity that is mild compared with mitral stenosis, slow rate of descent of velocity curve following peak velocity, and diastolic dispersion
  14. Tricuspid regurgitation peak velocity is proportional to the:

    diastolic pressure gradient between the RV & RA
    systolic pressure gradient between the RV & RA
    diastolic pressure gradient between the RV & PA
    systolic pressure gradient betwween the RV & RA
    systolic pressure gradient between the RV & RA

    RVSP can be estimated by taking the peak velocity of TR jet(systole), using Bernoulli's equation to predict peak RV minus RA pressure gradient. By estimating mean RA pressure as 10 mmHg and adding that to the above finding, RVSP is estimated
  15. During a contrast study, contrast appearing in the IVC and hepatic veins during right ventricular systole indicates:

    tricuspid stenosis
    tricuspid insufficiency
    pulmonary hypertension
    pulmonary insufficiency
    tricuspid insufficiency
  16. True/False:  The differences in timing of the opening and closing of the mitral valve and tricuspid valves are

    tricuspid valve closure occurs prior to mitral valve closure
    tricuspid valve closure occurs after mitral valve closure
    tricuspid valve opening occurs prior to mitral valve opening
    tricuspid valve opening occurs after the mitral valve opening
    F, T, T, F
  17. The PLAX right ventricular inflow view demostrates which tricuspid valve leaflets?

    anterior and septal
    anterior and posterior
    septal and posterior
    inferior and posterior
    anterior and posterior

    3 TV valve are the anterior, posterior and septal. In the parasternal RVIT veiw, anterior & posterior are imaged. PSAX all 3 leaflets are imaged optimally. A4 veiw demonstrates the anterior and septal leaflets
  18. True/False:  To distinguish the tricuspid valve from the mitral valve when attempting to identify the morphologyof the right ventricle, one looks for

    * more apical insertion of the septal leaflet of the tricuspid valve(in relation to the anterior mitral leaflet)
    * more basil insertion of the septal leaflet of the tricuspid valve(in relation to the anterior mitral leaflet)
    * the trileaflet configuration of the tricuspid valve
    * presence of four distinct papillary muscles
    T, F, T, F

    the apical insertion of the tricuspid setal leaflet relative to the mitral anterior leaflet distinguishes the RV when there is any doubt. TV has 3 leaflets and also papillary muscles, not four.
  19. True/False:  Tricuspid valve echo finding in patients with such acquired diseases as endomyocardial fibrosis, endocardial fibroelastosis, and malignant carcinoid include:

    increased E to A ratio
    thickened leaflets and chordae
    diastolic leaflet doming
    restriction of leaflet motion
    F, F, T, T

    group of acquired disorders presents on the echo with findings of TS: thickened cordae, distolic leaflet doming, and restriction of leaflet motion. E:A ration would be either decreased or, owing to lact of an A wave, nonsxistent
  20. True/False:  The most reliable views for demostrating doming of the stenotic tricuspid valve are

    PLAX, right ventricular inflow
    PSAX
    Apical 4C
    all of the above
    T, F, T, F

    PLAX RVIT and the A4 view are the most reliable for veiwing doming in TS. PSAX is less reliable, although it may at times be domed
  21. True/False:  Signs of right ventricular volume overload in tricuspid regurgitation include.

    dilatation of the right ventricle
    dilatation fo the right atrium
    flattening of the septum during diastole
    anterior motion of the IVS during isovolumetri contraction
    T, F, T, T

    dilatation of RA occurs in TR but is not a sign of RVVO. The other signs are all true of RVVO

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