ARDMS Echo Valvular Heart Disease 2 — Questions and Answers
Question 1: What is the classic M-mode finding in severe mitral regurgitation caused by a flail leaflet?
- Chaotic fluttering of the posterior mitral leaflet into the LA in systole (Correct answer)
- Anterior systolic motion of the posterior leaflet
- Fixed, non-moving mitral leaflet
- Diastolic fluttering of the anterior leaflet
Correct answer: Chaotic fluttering of the posterior mitral leaflet into the LA in systole
A flail mitral leaflet on M-mode shows chaotic, high-frequency systolic motion of the leaflet tip into the LA due to chordal rupture.
Question 2: Which parameter best differentiates severe mitral regurgitation from moderate on echocardiography using the PISA method?
- EROA ≥ 0.40 cm² and regurgitant volume ≥ 60 mL (Correct answer)
- EROA ≥ 0.20 cm² and regurgitant volume ≥ 30 mL
- EROA ≥ 0.10 cm² and regurgitant volume ≥ 15 mL
- Vena contracta ≥ 0.3 cm only
Correct answer: EROA ≥ 0.40 cm² and regurgitant volume ≥ 60 mL
Severe primary MR criteria include EROA ≥0.40 cm² and regurgitant volume ≥60 mL per ASE/AHA/ACC guidelines.
Question 3: What is the Doppler half-time for severe aortic regurgitation (PHT < X ms)?
- < 200 ms (Correct answer)
- > 500 ms
- 200–400 ms
- 400–600 ms
Correct answer: < 200 ms
A pressure half-time <200 ms in aortic regurgitation indicates severe AR because rapid equilibration of aortic and LV pressures occurs.
Question 4: Which echocardiographic sign in aortic regurgitation indicates severe volume overload and correlates with poor prognosis without surgery?
- LV end-systolic dimension > 5.0 cm (Correct answer)
- LV end-diastolic dimension > 6.0 cm only
- LA dilation only
- Normal LV dimensions
Correct answer: LV end-systolic dimension > 5.0 cm
An LV end-systolic dimension >5.0 cm in chronic severe AR is a guideline indication for aortic valve replacement even in asymptomatic patients.
Question 5: What echocardiographic feature distinguishes organic (primary) from functional (secondary) mitral regurgitation?
- Structural leaflet abnormality (prolapse, flail, restricted) in primary; normal leaflets with tethering in secondary (Correct answer)
- Severity of MR only
- Presence of LA dilation only
- LV systolic function only
Correct answer: Structural leaflet abnormality (prolapse, flail, restricted) in primary; normal leaflets with tethering in secondary
Primary MR involves intrinsic leaflet pathology; secondary (functional) MR occurs in the setting of LV dilation/dysfunction with normal leaflets that fail to coapt due to tethering.
Question 6: Which feature of the aortic valve on echocardiography is most consistent with infective endocarditis?
- Mobile, oscillating echogenicity attached to a leaflet (vegetation) (Correct answer)
- Calcified, immobile leaflet
- Leaflet thickening without mobility
- Aortic annular calcification only
Correct answer: Mobile, oscillating echogenicity attached to a leaflet (vegetation)
Vegetations in endocarditis appear as mobile, oscillating, irregularly shaped echogenic masses attached to valve leaflets, typically on the low-pressure side.
ARDMS Echo Valvular Heart Disease 2
What is the classic M-mode finding in severe mitral regurgitation caused by a flail leaflet?