ARDMS Echo Doppler Principles and Applications 2 — Questions and Answers
Question 1: The PISA (proximal isovelocity surface area) method is used to quantify which cardiac abnormality?
- Regurgitant valve orifice area and flow (Correct answer)
- Stenotic valve gradient
- Cardiac output
- LV filling pressure
Correct answer: Regurgitant valve orifice area and flow
The PISA method calculates effective regurgitant orifice area (EROA) and regurgitant volume by measuring the radius of the convergence hemisphere upstream of a regurgitant orifice.
Question 2: Which Doppler finding characterizes severe mitral regurgitation on continuous wave Doppler?
- Dense, triangular-shaped MR signal with early peak (Correct answer)
- Faint, parabolic MR signal
- Holosystolic MR signal with late peak
- Absent MR signal
Correct answer: Dense, triangular-shaped MR signal with early peak
Severe MR produces a dense, triangular CW Doppler signal peaking early due to rapid equalization of LV and LA pressures.
Question 3: What does a pulmonary vein systolic flow reversal on Doppler indicate?
- Severe mitral regurgitation (Correct answer)
- Mild mitral stenosis
- Normal left atrial pressure
- Tricuspid regurgitation
Correct answer: Severe mitral regurgitation
Systolic flow reversal in pulmonary veins is a specific finding for severe mitral regurgitation reflecting elevated LA pressure and retrograde jet.
Question 4: Which Doppler parameter is measured to estimate mean mitral valve gradient in mitral stenosis?
- Mean pressure gradient from the mitral inflow VTI (Correct answer)
- Peak E velocity only
- IVRT only
- A-wave duration
Correct answer: Mean pressure gradient from the mitral inflow VTI
Mean pressure gradient in MS is derived by tracing the mitral inflow Doppler envelope and applying the modified Bernoulli equation across the diastolic period.
Question 5: In Doppler echocardiography, what does the velocity-time integral (VTI) represent?
- Stroke distance — the linear distance blood travels per beat (Correct answer)
- Blood flow velocity at a single instant
- Average velocity over one cardiac cycle
- Peak systolic velocity
Correct answer: Stroke distance — the linear distance blood travels per beat
VTI (cm) represents the distance blood travels per cardiac cycle, calculated by integrating velocity over time from the Doppler spectral envelope.
Question 6: What is the significance of a Doppler-derived mean aortic valve gradient > 40 mmHg?
- Severe aortic stenosis (Correct answer)
- Mild aortic stenosis
- Normal aortic valve function
- Moderate aortic regurgitation
Correct answer: Severe aortic stenosis
A mean aortic valve gradient >40 mmHg (with normal flow) is consistent with severe aortic stenosis per ASE/ACC/AHA guidelines.
ARDMS Echo Doppler Principles and Applications 2
The PISA (proximal isovelocity surface area) method is used to quantify which cardiac abnormality?