Order Congenital Valve Lesions Discussion

Order Congenital Valve Lesions Discussion
Order Congenital Valve Lesions Discussion
1. Based upon the demonstrated ndings on the echo shown
(Video 35.1 and Fig. 35.1), what additional congenital
lesions should be sought in an asymptomatic 24-year-old
female, BP 152/84?
A. Bicuspid aortic valve (BAV) only
B. BAV and subaortic membrane
C. BAV and a ruptured cerebral artery berry aneurysm
D. Parachute tricuspid valve with stenosis
E. BAV, subaortic membrane, and a ruptured berry
aneurysm
2. What would be the most appropriate clinical recommendation for an asymptomatic patient with a nonstenotic
bicuspid aortic valve and the echo shown in Figure 35.2?
Previous reports have demonstrated similar echocardiographic ndings:
A. Urgent MRI.
B. Refer the patient for surgical aortic root replacement.
C. Repeat echocardiographic imaging in 1 year.
D. Routine advanced imaging of aorta (MR or CT) in
2 years.
E. Urgent CT scan.
3. When would it be reasonable to refer the patient with the
congenital heart lesion shown in Video 35.2 for surgical
repair?
A. LVOT peak Doppler gradient is 40 mm Hg; the patient
is asymptomatic.
B. Pregnancy is being planned; LVOT mean Doppler
gradient is <30 mm Hg.
C. The patient plans to join a recreational curling team;
LVOT mean Doppler gradient is <30 mm Hg.
D. Echo demonstrates mild aortic regurgitation.
E. Chordal systolic anterior motion of the mitral apparatus
is noted with no mitral regurgitation.
Chapter 35
Congenital Valve Lesions
Scott Klewer
Figure 35.1
Figure 35.2
Order Congenital Valve Lesions Discussion
(c) 2015 Wolters Kluwer. All Rights Reserved.
Chapter 35 Congenital Valve Lesions 305
8. What is the likely underling cardiac malformation (shown
in Video 35.7) affecting a 44-year-old with no prior cardiac
history who presents with pulmonary edema and CHF
symptoms?
Note: Apical echo image is inverted upright (apex down) as
preferred by congenital cardiologist.
A. D-transposition of the great vessels
B. Double outlet right ventricle
C. Shone complex
D. L-transposition of the great vessels (CCTGA)
E. Tricuspid atresia
9. Which of the following repairs for congenital heart disease does not include placement of a right ventricular to
pulmonary artery conduit?
A. Ross procedure
B. Konno repair
C. Complete truncus arteriosus repair
D. Rastelli repair
10. What would be the most appropriate referral for this
24-year-old Jehovah’s Witness who underwent a staged
repair for a large VSD during childhood, presenting
now with syncope and the echocardiographic ‹ndings
in Videos 35.8 and 35.9 and Figure 35.4?
4. Which of the following echocardiographic images should
be most carefully investigated in this patient with Williams
syndrome (Video 35.3)?
A. Speckle tracking to assess LV strain
B. Parasternal short-axis imaging of the coronary artery origins
C. Subcostal long-axis imaging of the atrial septum
D. High parasternal angled views to image the branch
pulmonary arteries
E. Suprasternal notch imaging of the proximal descending
aorta
5. What would be the most appropriate recommendation for
a 30-year-old with dyspnea on exertion and echo ‹ndings
similar to those shown in Video 35.4 and Figure 35.3?
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