Shared Flashcard Set

Details

prosthetic valves
2nd semester
51
Health Care
Undergraduate 2
04/28/2009

Additional Health Care Flashcards

 


 

Cards

Term

What kind of valves are Hancock and Carpentier-Edwards?

Definition

Porcine valves

Term

Which brand name of porcine valves is the most common?

Definition

Carpentier-Edwards

Term

In what valve positions are Hancock and Carpentier-Edwards’ valves used?

Definition

Mitral, aortic and tricuspid valve positions

Term

How long will a Carpentier-Edwards or a Hancock valve last?

Definition

10 – 15 yrs

Term

How are Carpentier-Edwards or Hancock valves made?

Definition

They are constructive of aortic porcine valves sewn to a metal wire stent, often made from a cobalt-nickel alloy.  The wire is bent to form three U-shaped prongs.  A Dacron cloth sewing skirt is attached to the base of the wire stent, and the stents themselves are also covered with cloth.

Term

True/False- Carpentier-Edwards or Hancock valves are treated with gluteraldehyde to make them stiffer?

Definition

TRUE

Term

What is a disadvantage of Carpentier-Edwards or Hancock valves?

Definition

Limited sizes are available & Small valve sizes will sometimes have “incomplete openings” due to small orifice, and with lower flow rates, creates a favorable environment for failure (size mismatch).

 

Term

What kind of valve is an Ionescu-Shiley valve?

Definition

Bovine tissue valve

Term

What material is used to make Ionescu-Shiley valves?

Definition

Fashioned from cow pericardium

Term

How will an Ionescu-Shiley valve fail?

Definition

Valvular regurgitation or stenosis are the common methods of failure.

Term

What is the advantage of Ionescu-Shiley valves?

Definition

Unlimited range of sizes can be custom designed.

 

Term

What are the brand names of Ball-In-Cage valves?

Definition

Starr Edwards silastic ball, Starr Edwards satellite ball, & Smeloff Cutter

Term

What was the brand name of the first mechanical valve in 1952 and what type of mechanical valve was it?

Definition

Starr Edwards silastic ball & Ball-In-Cage  

Term

How are Smeloff Cutter or Starr Edwards valves constructed?

Definition

Two U-shaped struts form a cage that houses a silastic ball occluder.

 

Term

What is the mechanism of failure for a Smeloff Cutter or Starr Edwards valve?

Definition

The ball would swell and freeze in the open or closed position

Term

What type of medication will a patient have to take with a Smeloff Cutter or Starr Edwards valve?

Definition

Anticoagulants- mechanical valves have increased thrombogenicity.

 

Term

What is the disadvantage of Smeloff Cutter or Starr Edwards valves?

Definition

The ball was notorious for causing damage to blood cells due to collisions.

Term

Are Smeloff Cutter or Starr Edwards valves still being used today?

Definition

No, they were eventually taken off the market.

 

Term

What kind of valves are Medtronic-Hall or Bjork-Shiley valves?

Definition

Single Disc Tilting Disc valves

Term

Which brand name of Single Disc Tilting Disc valves is the most common?

Definition

Bjork-Shiley valves & Single Disc Tilting Disc valves

Term

How was the Bjork-Shiley or Medtronic-Hall valves supposed to be an improvement over Starr Edwards or Smeloff Cutter valves?

Definition

Bjork-Shiley or Medtronic-Hall valves were designed to mimic the natural patterns of blood flow.  This reduced damage to blood cells, improved flow patterns, reduced blood clotting and infections.

Term

What is the mechanism of failure for a Bjork-Shiley or Medtronic-Hall valve?

Definition

The struts tend to fracture due to fatigue from repeated ramming of the struts by the disc.

 

Term

How are Bjork-Shiley or Medtronic-Hall valves constructed?

Definition

A polymer disc held in place by 2 welded struts.  The disc floats between the two struts in such a way, as to close when the blood begins to travel backward and then reopens when blood begins to travel forward again.

 

Term

How are St. Jude’s or CarboMedics valves constructed?

Definition

Consisted of 2 semi-circular leaflets that pivot on hinges.  The carbon leaflets were strong and had excellent biocompatibility.

 

Term

When was the first St. Jude’s or CarboMedics valves introduced?

Definition

1979

Term

When performing Doppler on a St. Jude’s or CarboMedics valve where should the cursor be placed to get an accurate velocity? Why?

Definition

Move the cursor to the side a little because the unusual profile causes the flow velocities to be higher when obtained from the central, slit like orifice.

Term

True/False- St. Jude’s or CarboMedics valves provide the closest approximation to central flow achieved in a natural heart valve.

Definition

TRUE- The leaflets swing open completely, parallel to the direction of blood flow. 

 

Term

True/False- St. Jude’s or CarboMedics valves are considered an ideal valve.

Definition

FALSE- The leaflets don’t close completely, which allows some backflow. Since this is a property of a defective valve, the bi-leaflet valve is still not an ideal valve. 

 

Term

What are the brand names of Bi-Leaflet Tilting Disc valves?

Definition

St. Jude’s & CarboMedics

Term

Which brand name of Bi-leaflet Tilting Disc valves is the most common?

Definition

St. Jude’s valves

Term

True/False- Regurgitation of prosthetic valves appears the same severity on both TTE and TEE?

Definition

FALSE- The regurgitation always appears worse on TEE than on TTE.

Term

List 4 things in which serial exams of prosthetic valves will include.

Definition

1-      CW velocities (antegrade) through the valve,

2-      Look for any change in the amount of “normal” prosthetic valvular regurgitation

3-      Appearance of perivalvular leaks d/t dehiscence or abscess

4-      Heart changes such as LVH, chamber dilatation, or ventricular dysfunction d/t wrong size valve used.

 

Term

Is a baseline echo needed for a prosthetic valve once the valve has been implanted?

Definition

YES- a baseline echo will establish what is normal for the prosthetic valve and can be used to compare later echo studies to see if anything has changed with the prosthetic valve.

 

Term

True/False- Wedge pressures are not affected by implantation of prosthetic valves.

Definition

FALSE- Once a prosthetic valve is in place, invasive information of valvular malfunction in the mitral or aortic position requires transthoracic or transeptal puncture cardiac catherization to assess the hemodynamics.  Wedge pressures can no longer be performed.

 

Term

What kind of information does a “medical device card (MDC)” provide?

Definition

Manufacturer of prosthetic valve, model number of prosthetic valve and size of prosthetic valve

Term

How will velocities change with prosthetic valve in comparison to a native valve?

Definition

Peak velocities will be increased with a prosthetic valve from those obtained in native valves.

Term

List the Doppler tools which are used for assessment of all prosthetic valves.

Definition

1- CW

2- Color Doppler

Term

True/False- The continuity equation can be used for all prosthetic valves to calculate the AVA.

Definition

FALSE- The continuity equation can be used to tissue valves, but not mechanical valves.

Term

What is the name of the index which is used for assessment of the aortic valve prosthetics and what kind of prosthetic valve uses it?

Definition

Dimensionless Index & Mechanical Valves

Term

What is the ratio used for calculation of the dimensionless index for mechanical valves?

Definition

LVOT VTI ÷ AOV VTI

Term

Using a VTI of 15 for LVOT and a VTI of 51 for the AOV, calculate the ratio and is it stenotic?

Definition

15÷51 = .29

Yes- <0.3 is stenotic

Term

What are the units of the dimensionless index?

Definition

There are no units for the dimensionless index.

Term

What’s the normal range for the dimensionless index and when is it considered to be stenotic?

Definition

Normally between 0.35 - 0.5

<0.3 is stenotic

Term

What valve positions can be assessed with the P1/2T & VTI tracing methods?

Definition

Mitral and Tricuspid valve areas

Term

Which method is more accurate for calculating prosthetic valve velocities in the mitral and tricuspid valve positions?

Definition

VTI calculation to get the mean gradient is more accurate.  Normal values must be looked up in a table for each valve.

Term

When should a baseline ratio be performed?

Definition

6 months after surgery

Term

List everything that can assess regurgitation in a prosthetic valve.

Definition

1-      Color to determine jet width, origin, and jet area

2-      PW to look for S wave reversal in the pulmonary or hepatic veins with severe MR or TR

3-      PW to assess severity of AI in descending aorta

4-      CW to assess flow shape for acute or chronic MR and severity

 

Term

True/ False- It can be very difficult to discern perivalvular leakage d/t the fact that many mechanical valves normally have unusual color patterns that make it difficult to tell.

Definition

TRUE

Term

How will a ring abscess appear on 2D echo?

Definition

An anechoic area surrounding the annulus

 

Term

What is the brand name of the prosthetic valves which are in clinical trials and are not yet approved by the FDA?

Definition

3F Therapeutics

Term

True/False- Anechoic areas in the annulus suggest perivalvular abscess, color Doppler is necessary to determine the presence of perivalvular leakage in patients with no dehiscence.

Definition

TRUE

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