MCQs IN CARDIOLOGY based on BRAUNWALD by DR.

ADITHYA UDUPA K

Aortic Valve Disease

Question Principal causes of valvular AS are all except

Type multiple_choice

Option Rheumatoid involvement of aortic valve correct

Option Rheumatic involvement of aortic valve incorrect

Option Degenerative aortic valve stenosis incorrect

Option Bicuspid aortic valve stenois incorrect

Solution Answer. A

Valvular AS has three principal causes: a congenital bicuspid valve with superimposed
calcification, calcification of a normal trileaflet valve, and rheumatic disease

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Question Hypercholesterolemia associated with aortic stenosis is

Type multiple_choice

Option Type IV hyperlipoproteinemia incorrect

Option Type I hyperlipoproteinemia incorrect

Option Type III hyperlipoproteinemia incorrect

Option Type II hyperlipoproteinemia correct

Solution Answer. D

AS may be caused by a congenital valve stenosis manifesting in infancy or childhood.

Rarely, AS is caused by severe atherosclerosis of the aorta and aortic valve; this form
of AS occurs most frequently in patients with severe hypercholesterolemia and is
observed in children with homozygous type II hyperlipoproteinemia. Rheumatoid
involvement of the valve is a rare cause of AS and results in nodular thickening of the
 valve leaflets and involvement of the proximal portion of the aorta. Ochronosis with
alkaptonuria is another rare cause of AS.

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Question All can cause aortic valve stenosis except

Type multiple_choice

Option Marfans disease correct

Option Rheumatoid arthritis incorrect

Option Alkaptonuria incorrect

Option Type II hyperlipoproteinemia incorrect

Solution Answer. A

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Question The most common malformations found in fatal valvular AS in children younger than
1 year is

Type multiple_choice

Option Unicuspid aortic valve stenosis correct

Option Bicuspid aortic valve stenosis incorrect

Option Quadricuspid aortic valve stenosis incorrect

Option Supravalvular stenosis due to Williams syndrome incorrect

Solution Answer. A

Unicuspid valves typically produce severe obstruction in infancy and are the most
common malformations found in fatal valvular AS in children younger than 1 year, but
also may be seen in young adults with an anatomy that mimics bicuspid valve disease.
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Question Frequency of presentation of bicuspid aortic valve in childhood

Type multiple_choice

Option Normal valve function >aortic valve regurgitation > aortic valve correct
stenosis

Option Aortic valve stenosis > aortic valve regurgitation > normal valve incorrect
function

Option Aortic valve regurgitation > aortic valve stenosis > normal aortic incorrect
valve function

Option All are equal incorrect

Solution Answer. A

Congenitally bicuspid valves rarely are responsible for serious narrowing of the aortic
orifice during childhood, but do cause significant aortic regurgitation (AR) requiring
valve surgery in young adulthood in a subset of patients. Most affected patients,
however, have normal valve function until late in life, when superimposed calcific
changes result in valve obstruction

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Question Strongly associated with progression of calcific aortic valve disease is

Type multiple_choice

Option Baseline calcium score correct

Option Hypertension incorrect

Option Diabetes incorrect

Option Dyslipedemia incorrect

Solution Answer. A
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Question Both MS and AS most commonly seen with

Type multiple_choice

Option Rheumatic affection correct

Option Degenerative disease incorrect

Option Congenital etiology incorrect

Option Rheumatologic affection incorrect

Solution Answer. A

Rheumatic AS results from adhesions and fusions of the commissures and cusps and
vascularization of the leaflets of the valve ring, leading to retraction and stiffening of
the free borders of the cusps. Calcific nodules develop on both surfaces, and the
orifice is reduced to a small, round or triangular opening. As a consequence, the
rheumatic valve often is regurgitant as well as stenotic. Patients with rheumatic AS
invariably have rheumatic involvement of the mitral valve

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Question Both AR and AS most commonly seen with

Type multiple_choice
Option Rheumatic affection correct

Option Degenerative disease incorrect

Option Congenital etiology incorrect

Option Rheumatologic affection incorrect

Solution Answer. A

Rheumatic AS results from adhesions and fusions of the commissures and cusps and
vascularization of the leaflets of the valve ring, leading to retraction and stiffening of
the free borders of the cusps. Calcific nodules develop on both surfaces, and the
orifice is reduced to a small, round or triangular opening. As a consequence, the
rheumatic valve often is regurgitant as well as stenotic. Patients with rheumatic AS
invariably have rheumatic involvement of the mitral valve

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Question Symptomatic severe AS belongs to stage

Type multiple_choice

Option A incorrect

Option C incorrect

Option D correct

Option B incorrect

Solution Answer. C
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Question An aortic jet velocity of 2.0 to 2.9 m/sec or mean transvalvular pressure gradient less
than 20 mm Hg, usually with aortic orifice of 1.5 to 2.0 cm2 is seen with

Type multiple_choice

Option Mild AS correct

Option Normal aortic valve incorrect

Option Moderate AS incorrect

Option Severe AS incorrect

Solution Answer. A

Severe obstruction to LV outflow usually is characterized by the following: (1) an

aortic jet velocity of 4 m/sec or greater; (2) a mean transvalvular pressure gradient at
least 40 mm Hg in the presence of a normal flow; or (3) an effective aortic orifice no
greater than 1.0 cm2 in an average-sized adult (i.e., ≤0.6 cm2/m2 of body surface
area), which is approximately 25% of the normal aortic orifice of 3.0 to 4.0 cm2.19
Moderate AS is characterized by an aortic jet velocity of 3.0 to 3.9 m/sec or mean
transvalvular pressure gradient of 20 to 39 mm Hg, usually with an aortic valve orifice
area (AVA) of 1.0 to 1.5 cm2. Mild AS is characterized by an aortic jet velocity of 2.0 to
 2.9 m/sec or mean transvalvular pressure gradient less than 20 mm Hg, usually with
aortic orifice of 1.5 to 2.0 cm2

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Question All are true about pathophysiology of aortic stenosis except

Type multiple_choice

Option Left atrium prevents the pulmonary venous and capillary pressures incorrect
from rising to levels that would produce pulmonary congestion

Option Atrial fibrillation (AF) may result in rapid clinical deterioration in incorrect
patients with severe AS

Option After surgical relief of AS, diastolic dysfunction reverts completely correct
toward normal with regression of hypertrophy

Option Atrioventricular dissociation, may result in rapid clinical deterioration incorrect

in patients with severe AS

Solution Answer. C

The “booster pump” function of the left atrium prevents the pulmonary venous
and capillary pressures from rising to levels that would produce pulmonary
congestion, while maintaining LV end-diastolic pressure at the elevated level
necessary for effective contraction of the hypertrophied left ventricle. Loss of
appropriately timed, vigorous atrial contraction, as occurs in atrial fibrillation (AF) or
atrioventricular dissociation, may result in rapid clinical deterioration in patients with
severe AS. After surgical relief of AS, diastolic dysfunction may revert toward normal
with regression of hypertrophy, but some degree of long-term diastolic dysfunction
typically persists.

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Question Severe pulmonary hypertension may be seen in upto

Type multiple_choice

Option 40-50% incorrect

Option 30-40% incorrect

Option 5-15% incorrect

Option 15-20% correct

Solution Answer. D

The hypertrophied and pressure overloaded left ventricle transmits increased

pressure to the pulmonary vasculature, which leads to pulmonary hypertension in
many patients with AS, becoming severe in 15% to 20%.

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Question The most common clinical presentation in patients with a known diagnosis of AS is

Type multiple_choice

Option Dyspnea on exertion correct

Option Angina incorrect

Option Dyspnea on rest incorrect

Option Syncope incorrect

Solution Answer. A

The most common clinical presentation in patients with a known diagnosis of AS who
are followed prospectively is a gradual decrease in exercise tolerance, fatigue, or
dyspnea on exertion.

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Question Syncope in severe AS maybe due to all except

Type multiple_choice

Option Syncope at rest may be caused by transient VF with loss of the correct
 ventricular contribution, which causes a precipitous decline in
cardiac output

Option Syncope maybe due to transient atrioventricular (AV) block caused incorrect
by extension of the calcification of the valve into the conduction
system.

Option Syncope also has been attributed to malfunction of the baroreceptor incorrect
mechanism in severe AS

Option Syncope maybe due to a vasodepressor response to a greatly incorrect

elevated LV systolic pressure during exercise

Solution Answer. A

Syncope most often is caused by the reduced cerebral perfusion that occurs during
exertion when arterial pressure declines because of systemic vasodilation and an
inadequate increase in cardiac output related to valvular stenosis. Syncope also has
been attributed to malfunction of the baroreceptor mechanism in severe AS, as well
as to a vasodepressor response to a greatly elevated LV systolic pressure during
exercise. Premonitory symptoms of syncope are common. Exertional hypotension also
may be manifested as “graying-out spells” or dizziness on effort. Syncope at rest
may be caused by transient AF with loss of the atrial contribution to LV filling, which
causes a precipitous decline in cardiac output, or to transient atrioventricular (AV)
block caused by extension of the calcification of the valve into the conduction system.

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Question All are true about GI bleed in severe AS except

Type multiple_choice

Option Often associated with angiodysplasia and most frequently on left correct
colon

Option Angiodysplasia is due to shear stress–induced platelet aggregation incorrect

with a reduction in high-molecular-weight multimers of von
Willebrand factor and increases in proteolytic subunit fragments.

Option Extent of angiodysplasia correlates with severity of AS incorrect

Option Angiodysplasia is correctable by AVR incorrect

Solution Answer. A

Gastrointestinal (GI) bleeding may develop in patients with severe AS, often
associated with angiodysplasia (most frequently of the right colon) or other vascular
malformations. This complication arises from shear stress–induced platelet
aggregation with a reduction in high-molecular-weight multimers of von Willebrand
factor and increases in proteolytic subunit fragments. These abnormalities correlate
with the severity of AS and are correctable by AVR.

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Question An increased risk of infective endocarditis in patients with AS is seen with

Type multiple_choice

Option Older patients with degenerative aortic valve incorrect

Option Younger patients with rheumatic aortic valve incorrect

Option Younger patients with bicuspid aortic valve correct

Option Calcific severe AS at any age incorrect

Solution Answer. C

An increased risk of infective endocarditis has been documented in patients with

aortic valve disease, particularly in younger patients with a bicuspid valve

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Question Finding which is specific for severe AS is

Type multiple_choice

Option Parvus and tardus carotid impulse correct

Option Palpable carotid thrill incorrect

Option Gallavardian murmur incorrect

Option Single S2 incorrect

Solution Answer. A

The expected finding with severe AS is a slow-rising, late-peaking, low-amplitude

carotid pulse, the parvus and tardus carotid impulse. When present, this finding is
specific for severe AS.

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Question In patients with severe noncalcific AS all can be seen except

Type multiple_choice

Option Parvus and tardus carotid impulse incorrect

Option Palpable carotid thrill incorrect

Option Gallavardian murmur correct

Option Single S2 incorrect

Solution Answer. C

In patients with calcified aortic valves, the systolic murmur is loudest at the base of
the heart, but high-frequency components may radiate to the apex—the so-called
Gallavardin phenomenon, in which the murmur may be so prominent that it is
mistaken for the murmur of mitral regurgitation (MR). In general, a louder and later-
peaking murmur indicates more severe stenosis.

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Question In severe AS, S2 maybe single because of all below reasons except

Type multiple_choice
Option Calcification and immobility of the aortic valve make A2 inaudible incorrect

Option Increased hangout interval of pulmonary circulation causing delayed correct

P2 and single S2

Option Closure of the pulmonic valve (P2) is buried in the prolonged aortic incorrect
ejection murmur

Option Prolongation of LV systole makes A2 coincide with P2 incorrect

Solution Answer. B

Splitting of S2 is helpful in excluding the diagnosis of severe AS, because normal

splitting implies the aortic valve leaflets are flexible enough to create an audible
closing sound (A2). With severe AS, S2 may be single because (1) calcification and
immobility of the aortic valve make A2 inaudible, (2) closure of the pulmonic valve
(P2) is buried in the prolonged aortic ejection murmur, or (3) prolongation of LV
systole makes A2 coincide with P2

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Question All are true about dynamic auscultation in aortic stenosis except

Type multiple_choice

Option The murmur of valvular AS is augmented by squatting incorrect

Option The murmur is reduced in intensity during the strain of the Valsalva incorrect
maneuver

Option The murmur is reduced in intensity during standing incorrect

Option The intensity of the systolic murmur doesn’t varie from beat to beat correct
in AF and its helpful to differentiate from MR

Solution Answer. D

The intensity of the systolic murmur varies from beat to beat when the duration of
diastolic filling varies, as in AF or after a premature contraction. This characteristic is
helpful in differentiating AS from MR, in which the murmur usually is unaffected. The
murmur of valvular AS is augmented by squatting, which increases stroke volume. It is
reduced in intensity during the strain of the Valsalva maneuver and on standing, both
 of which reduce transvalvular flow.

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Question Main factor affected in paradoxical low-flow, low-gradient AS is

Type multiple_choice

Option Stroke volume index correct

Option LVEF incorrect

Option Valve area incorrect

Option Transvalvular gradient incorrect

Solution Answer. A

Low-flow, low-gradient AS also can occur with a normal LVEF (≥50%), typically in
elderly patients with a small, hypertrophied left ventricle or those with concurrent
hypertension. This is often referred to as paradoxical low-flow, low-gradient AS
(ACC/AHA stage D3; AVA ≤1.0 cm2 with aortic velocity <4.0 m/sec or mean gradient
<40 mm Hg, and LVEF ≥50%) because despite a normal EF, transaortic flow is low
(stroke volume index <35 mL/m2).

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Question All below are used with some benefit in severe AS patients with heart failure except

Type multiple_choice

Option Diuretics incorrect

Option Nitroprusside incorrect

Option Carvedilol correct

Option Sildenafil incorrect

Solution Answer. C

In patients with heart failure (HF) and volume overload, AVR is indicated, but diuretics
may reduce congestion and provide some symptomatic relief prior to valve
replacement. Patients with decompensated HF may benefit from medical therapy as a
bridge to definitive therapy with valve replacement. Nitroprusside has been used
during hemodynamic monitoring in the intensive care unit to unload the left heart,
reduce congestion, and improve forward flow. Similarly, phosphodiesterase type 5
inhibition has been shown to provide acute improvements in pulmonary and systemic
hemodynamics resulting in biventricular unloading. These medications may improve
the patient's hemodynamic status, allowing the AVR procedure to be performed more
safely.

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Question Most common cause of AR in developed countries is

Type multiple_choice

Option Rheumatic AR incorrect

Option AR due to aortic root disease correct

Option Bicuspid AR incorrect

Option Degenerative AR incorrect

Solution Answer. B

Among patients with isolated AR who undergo AVR, the percentage with aortic root
disease has been increasing steadily during the past few decades; it now represents
the most common cause and accounts for more than 50% of all such patients in some
series.

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Question Isolated congenital AR is due to

Type multiple_choice

Option Unicuspid valve incorrect

Option Quadricuspid valve incorrect

Option Bicuspid valve correct

Option Tricuspid valve incorrect

Solution Answer. C

Isolated congenital AR is an uncommon lesion on necropsy studies but, when present,

is usually associated with a bicuspid valve.

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Question Largest LV end-diastolic volumes are seen with

Type multiple_choice

Option Severe chronic MR incorrect

Option Chronic severe TR incorrect

Option Chronic severe AR correct

Option Chronic severe PR incorrect

Solution Answer. C

Patients with severe chronic AR have the largest LV end-diastolic volumes of any form
of heart disease, resulting in so-called cor bovinum.

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Question Nocturnal angina is more common with

Type multiple_choice

Option AS incorrect

Option PS incorrect

Option MR incorrect

Option AR correct

Solution Answer. D

Angina pectoris is prominent late in the course; nocturnal angina may be troublesome
and often is accompanied by diaphoresis, which occurs when the heart rate slows and
arterial diastolic pressure falls to extremely low levels. Patients with severe AR often
complain of an uncomfortable awareness of the heartbeat, especially on lying down,
and thoracic discomfort caused by pounding of the heart against the chest wall.

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Question Diastolic pressure maybe in normal range in severe AR in all of the below conditions
except

Type multiple_choice

Option AR with severe anemia correct

Option AR with COA incorrect

Option AR with heart failure incorrect

Option AR with significant AS incorrect

Solution Answer. A

Systolic arterial pressure is elevated, and diastolic pressure is abnormally low.

Korotkoff sounds often persist to zero even though the intra-arterial pressure rarely
falls below 30 mm Hg. The point of change in Korotkoff sounds (i.e., the muffling of
these sounds in phase IV) correlates with the diastolic pressure. As HF develops,
peripheral vasoconstriction may occur and arterial diastolic pressure may rise, even
though severe AR is present.
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Question All are true about examination in AR except

Type multiple_choice

Option Diastolic murmur is readily audible than systolic murmur correct

Option AR murmur may be distinguished from the murmur of pulmonic incorrect

regurgitation by its earlier onset (i.e., immediately after A2 rather
than after P2) and usually by the presence of a widened pulse
pressure.

Option When the murmur is musical (“cooing dove” murmur), it usually incorrect
signifies eversion or perforation of an aortic cusp

Option The severity of AR correlates better with the duration than with the incorrect
intensity of the murmur

Solution Answer. A

It may be distinguished from the murmur of pulmonic regurgitation by its earlier

onset (i.e., immediately after A2 rather than after P2) and usually by the presence of a
widened pulse pressure.

The severity of AR correlates better with the duration than with the intensity of the
murmur.

When the murmur is musical (“cooing dove” murmur), it usually signifies eversion
or perforation of an aortic cusp. In patients with severe AR and LV decompensation,
equilibration of aortic and LV pressures in late diastole abolishes the late diastolic
component of the regurgitant murmur.

The systolic murmur often is more readily audible than the diastolic murmur. It may
be higher-pitched and less rasping than the murmur of AS but often is accompanied
by a systolic thrill. Palpation of the carotid pulses will elucidate the cause of the
systolic murmur and differentiate it from the murmur of AS.

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Question All are true about examination in AR except

Type multiple_choice

Option A mid-diastolic and late diastolic apical rumble, the Austin Flint incorrect
murmur, is common in severe AR

Option Austin Flint murmur appears to be created by severe AR impinging correct

on the posterior leaflet of the mitral valve

Option A S3 maybe a sign of impaired LV function incorrect

Option A third heart sound (S3) correlates with an increased LV end- incorrect
diastolic volume

Solution Answer. B

A third heart sound (S3) correlates with an increased LV end-diastolic volume. Its
development may be a sign of impaired LV function, which is useful in identifying
patients with severe AR who are candidates for surgical treatment. A mid-diastolic
and late diastolic apical rumble, the Austin Flint murmur, is common in severe AR and
may occur in the presence of a normal mitral valve. This murmur appears to be
created by severe AR impinging on the anterior leaflet of the mitral valve or the free
LV wall; convincing evidence for obstruction to mitral inflow in these patients is
lacking.

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Question All are true about high-frequency fluttering of the anterior leaflet of the mitral valve
during diastole on Echo except

Type multiple_choice

Option Maybe seen in both acute and chronic AR incorrect

Option It does not develop when the mitral valve is rigid, as occurs with incorrect
rheumatic involvement
Option This sign is equivalent to Austin Flint murmur seen on examination incorrect

Option Its seen when AR is severe correct

Solution Answer. D

High-frequency fluttering of the anterior leaflet of the mitral valve during diastole
may be seen in acute and chronic AR. However, it does not develop when the mitral
valve is rigid, as occurs with rheumatic involvement. This sign, unlike the Austin Flint
murmur, is present even in mild AR and results from the movement imparted to the
anterior leaflet of the mitral valve by the jet of blood regurgitating from the aorta.

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Question Most accurate noninvasive technique for assessing LV end-systolic volume, diastolic
volume, and mass in AR is

Type multiple_choice

Option CMR correct

Option PET CT incorrect

Option SPECT incorrect

Option ECHO incorrect

Solution Answer. A

CMR provides accurate measurements of regurgitant volumes and the regurgitant

orifice in AR. It is the most accurate noninvasive technique for assessing LV end-
systolic volume, diastolic volume, and mass. CMR accurately quantifies the severity of
AR on the basis of the antegrade and retrograde flow volumes in the ascending aorta
and is recommended when echocardiographic evaluation of regurgitation is
suboptimal.

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Question All are true about treatment of severe AR except

Type multiple_choice

Option Symptomatic patients with severe AR should undergo AVR incorrect

Option If evidence of LV dysfunction is borderline or inconsistent, surgery is correct

indicated

Option If abnormalities are progressive and consistent, AVR should be incorrect

strongly considered, even in asymptomatic patients.

Option Operation should be deferred in asymptomatic patients with normal incorrect

and stable LV function

Solution Answer.B

Operation should be deferred in asymptomatic patients with normal and stable LV

function and should be recommended for symptomatic patients. In asymptomatic
patients with LV dilation or dysfunction, a decision should be based not on a single
abnormal measurement but rather on several observations of depressed performance
and impaired exercise tolerance, carried out at intervals of 2 to 4 months. If evidence
of LV dysfunction is borderline or inconsistent, continued close follow-up is indicated.
If abnormalities are progressive and consistent (i.e., LVEF <50% or LV end-systolic
diameter rises to >50 mm), AVR should be strongly considered, even in asymptomatic
patients.

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Question All are features seen on examination in acute severe AR except

Type multiple_choice

Option The peripheral signs of AR are often not impressive and certainly not incorrect
as dramatic as in patients with chronic AR

Option S1 may be normal or loud because of premature closure of the correct

mitral valve

Option Closure of the mitral valve may be incomplete, however, and incorrect
 diastolic MR may occur

Option The normal or only slightly widened pulse pressure may lead to incorrect
significant underestimation of the severity of the valvular lesion

Solution Answer. B

The peripheral signs of AR are often not impressive and certainly not as dramatic as in
patients with chronic AR. The normal or only slightly widened pulse pressure may lead
to significant underestimation of the severity of the valvular lesion. The LV impulse is
normal or almost normal, and the rocking motion of the chest characteristic of
chronic AR is not apparent. S1 may be soft or absent because of premature closure of
the mitral valve, and the sound of mitral valve closure in mid- or late diastole
occasionally is audible. Closure of the mitral valve may be incomplete, however, and
diastolic MR may occur.

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Question All are findings of acute severe AR except

Type multiple_choice

Option The early diastolic murmur of acute AR is lower-pitched and of incorrect

shorter duration

Option A systolic murmur is common, resulting in to-and-fro sounds incorrect

Option With premature diastolic closure of the mitral valve, the early correct
diastolic component of the Austin Flint murmur is eliminated

Option The Austin Flint murmur often is present but is of brief duration and incorrect
ceases when LV pressure exceeds left atrial pressure in diastole

Solution Answer. C

The early diastolic murmur of acute AR is lower-pitched and of shorter duration

compared with that of chronic AR, because as LV diastolic pressure rises, the (reverse)
pressure gradient between the aorta and left ventricle is rapidly reduced. A systolic
murmur is common, resulting in to-and-fro sounds. The Austin Flint murmur often is
present but is of brief duration and ceases when LV pressure exceeds left atrial
pressure in diastole. With premature diastolic closure of the mitral valve, the
 presystolic portion of the Austin Flint murmur is eliminated.

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Question Drug to be avoided in acute severe AR is

Type multiple_choice

Option ACEI incorrect

Option Nitroprusside incorrect

Option Beta blockers correct

Option Dobutamine incorrect

Solution Answer. C

Beta blockers and intra-aortic balloon counterpulsation are contraindicated, because

either lowering the heart rate or augmenting peripheral resistance during diastole can
lead to rapid hemodynamic decompensation.

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Question All are true about bicuspid aortic valve disease except

Type multiple_choice

Option More prevalent in men incorrect

Option Present in approximately 0.5% of population correct

Option Autosomal dominant inheritance with incomplete penetrance incorrect

Option BAV is associated with NOTCH1 gene incorrect

Solution Answer. B

A congenital bicuspid aortic valve (BAV) is present in approximately 1% to 2% of the

population and is more prevalent in men, accounting for 70% to 80% of cases. In a
 subset of patients with BAV, familial clustering consistent with an autosomal
dominant inheritance with incomplete penetrance has been documented. In some
families with BAV and associated congenital anomalies, a mutation in the NOTCH1
gene has been described.

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Question The most prevalent anatomy for a bicuspid valve is

Type multiple_choice

Option Fusion of right and left coronary cusps incorrect

Option Fusion of left and non coronary cusps incorrect

Option Fusion of right and noncoronary cusps incorrect

Option All are equal correct

Solution Answer. D

The most prevalent anatomy for a bicuspid valve is two cusps with a right-left systolic
opening, consistent with congenital fusion of the right and left coronary cusps, seen in
70% to 80% of patients. An anterior-posterior orientation, with fusion of the right and
noncoronary cusps, is less common, seen in approximately 20% to 30% of patients.
Fusion of the left and noncoronary cusps is rarely seen.

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Question Association between MVP and BAV is seen with

Type multiple_choice

Option Fusion of right and left coronary cusps incorrect

Option Fusion of left and non coronary cusps incorrect

Option Fusion of right and noncoronary cusps correct

Option All are equal incorrect

Solution Answer. C

Some studies have also suggested an association between BAV disease (anterior-
posterior leaflet opening) and mitral valve prolapse (MVP).

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Question BAV with family history of aortic dissection should be considered for aortic root
replacement is indicated if maximum aortic dimension measured in end-diastole
exceeds

Type multiple_choice

Option 45 mm incorrect

Option 50 mm correct

Option 55 mm incorrect

Option 60 mm incorrect

Solution Answer. B

If AVR is needed for stenosis or regurgitation, concurrent aortic root replacement is

recommended if the maximum aortic dimension (measured at end-diastole) exceeds
45 mm. Even in the absence of aortic valve disease, aortic root replacement is
recommended when the aortic dimension is 55 mm or greater in adults with BAV and
may be considered with an aortic diameter of 50 mm if there is a family history of
dissection or evidence of rapid progression.

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