ARDMS Echo Valvular Heart Disease 1 — Questions and Answers
Question 1: What echocardiographic finding is pathognomonic for rheumatic mitral stenosis?
- Hockey stick deformity of the anterior mitral leaflet (Correct answer)
- Mitral valve prolapse
- Flail posterior mitral leaflet
- Mitral annular calcification only
Correct answer: Hockey stick deformity of the anterior mitral leaflet
Rheumatic mitral stenosis causes commissural fusion and doming of the anterior mitral leaflet, producing a classic 'hockey stick' appearance on parasternal long-axis view.
Question 2: Which echocardiographic finding best distinguishes severe from moderate aortic regurgitation?
- Vena contracta width ≥ 0.6 cm (Correct answer)
- Pressure half-time < 400 ms only
- Color jet width > 25% of LVOT only
- Jet length reaching apex only
Correct answer: Vena contracta width ≥ 0.6 cm
A vena contracta width ≥0.6 cm is a reliable quantitative parameter for severe aortic regurgitation per ASE guidelines.
Question 3: What is the most common etiology of isolated severe tricuspid regurgitation in the United States?
- Functional (secondary to RV dilation/annular dilation) (Correct answer)
- Rheumatic disease
- Infective endocarditis
- Carcinoid syndrome
Correct answer: Functional (secondary to RV dilation/annular dilation)
Functional TR caused by RV dilation and tricuspid annular dilation (from pulmonary hypertension or LV dysfunction) is the most common cause of severe TR in the US.
Question 4: On echocardiography, mitral valve prolapse is defined as leaflet displacement of at least how many millimeters above the mitral annular plane?
- 2 mm (Correct answer)
- 5 mm
- 1 mm
- 3 mm
Correct answer: 2 mm
MVP is defined as systolic displacement of one or both mitral leaflet tips ≥2 mm above the mitral annular plane into the left atrium.
Question 5: What does a Wilkins score > 8 in mitral stenosis predict?
- Poor outcome with balloon mitral valvuloplasty (Correct answer)
- Excellent outcome with balloon mitral valvuloplasty
- Severe mitral regurgitation
- Absence of commissural fusion
Correct answer: Poor outcome with balloon mitral valvuloplasty
The Wilkins score assesses leaflet mobility, thickening, calcification, and subvalvular thickening; a score >8 predicts suboptimal results with percutaneous balloon mitral valvuloplasty.
Question 6: Which echocardiographic view best demonstrates aortic valve morphology to determine if it is bicuspid or tricuspid?
- Parasternal short-axis view at the aortic valve level (Correct answer)
- Apical five-chamber view
- Subcostal view
- Suprasternal notch view
Correct answer: Parasternal short-axis view at the aortic valve level
The parasternal short-axis view at the aortic valve level best shows the number of cusps and commissures, allowing identification of bicuspid vs. tricuspid aortic valves.
ARDMS Echo Valvular Heart Disease 1
What echocardiographic finding is pathognomonic for rheumatic mitral stenosis?