MCQs IN CARDIOLOGY based on BRAUNWALD by DR.

ADITHYA UDUPA K

Transcatheter Therapies for Valvular Heart Disease

Question Balloon valvuloplasty for congenital pulmonic stenosis was first done by

Type multiple_choice

Option Cribier incorrect

Option Hufnagel incorrect

Option Paul Dudley White incorrect

Option Jean Kan correct

Solution Answer. D

Historically, the first and quite successful transcatheter therapy for VHD was balloon
valvuloplasty for congenital pulmonic stenosis, developed by Dr. Jean Kan in 1982.

Marks 4 1

Question First balloon aortic valvuloplasty (BAV) was done by

Type multiple_choice

Option Cribier correct

Option Webb incorrect

Option Walther incorrect

Option Braunwald incorrect

Solution Answer. A

Transcatheter treatment of AS began in 1985 with balloon aortic valvuloplasty (BAV)

by Cribier
Marks 4 1

Question First balloon aortic valvuloplasty (BAV) was done by

Type multiple_choice

Option Cribier correct

Option Webb incorrect

Option Walther incorrect

Option Braunwald incorrect

Solution Answer. A

The ensuing decade led to improvements in valve and stent design along with
development of a delivery system, culminating in the first successful human
implantation by Cribier in 2002

Marks 4 1

Question The development of the retrograde transfemoral arterial route for TAVI done by

Type multiple_choice

Option Cribier incorrect

Option Webb correct

Option Walther incorrect

Option Braunwald incorrect

Solution Answer. B

Although additional implants were performed over the next few years, efforts to
expand to other centers and broaden experience were plagued by difficulties in safely
reproducing Cribier's original antegrade transseptal delivery. The development of the
retrograde transfemoral arterial route by Webb and colleagues and the antegrade
transapical approach by Walther and associates4 allowed expansion of the procedure
 to other operators and centers.

Marks 4 1

Question Self expandable TAVR valves are made up of

Type multiple_choice

Option Chromium incorrect

Option Nitinol correct

Option Copper incorrect

Option Magnesium incorrect

Solution Answer. B

The Edwards Sapien Valve (Edwards Lifesciences, Irvine, California) is a cobalt

chromium balloon-expandable valve with the valve leaflets made of treated bovine
pericardium. The original Sapien THV valve was replaced by the second-generation
Sapien XT valve and now the third-generation Sapien 3 valve. Most other TAVR valve
designs are self-expanding nitinol valves. CoreValve (Medtronic, Minneapolis,
Minnesota) is the most common self-expanding valve, now in its third generation as
the Evolut-PRO valve.

Marks 4 1

Question Third generation Self expandable TAVR valves is

Type multiple_choice

Option Edwards Sapien valve incorrect

Option Sapien THV valve incorrect

Option CoreValve valve incorrect

Option Evolut-PRO vavle correct

Solution Answer. D

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Question Trial using self expandable TAVR valve was

Type multiple_choice

Option PARTNER 1 incorrect

Option PARTNER 2 incorrect

Option SURTAVI correct

Option PARTNER 3 incorrect

Solution Answer. C

The PARTNER 2A trial randomized 2036 patients to the balloon-expandable Sapien

valve versus SAVR, and the SURTAVI trial randomized 1746 patients to a self-
expanding TAVR (84% CoreValve, 16% Evolut-R) versus SAVR. The results of both trials
demonstrated noninferiority of TAVR to SAVR for the composite endpoint of death
and stroke at 2 years.

Marks 4 1

Question The use of sophisticated neuroimaging with diffusion-weighted (DW) magnetic

resonance imaging (MRI) demonstrates the presence of embolic lesions in the brain of
TAVR patients upto

Type multiple_choice

Option 70-100% correct

Option 50-70% incorrect

Option 30-50% incorrect

Option 2-10% incorrect

Solution Answer. A

An early concern of TAVR was an increased risk of stroke associated with the
procedure. The incidence of clinically evident stroke both in randomized trials when
examined by a neurologist and in clinical commercial registries ranges from 2% to
9%.13 However, the use of sophisticated neuroimaging with diffusion-weighted (DW)
magnetic resonance imaging (MRI) demonstrates the presence of embolic lesions in
the brain in 68% to 100% of patients undergoing TAVR

Marks 4 1

Question All are true about requirement for a new, permanent pacemaker in patients with
TAVR except

Type multiple_choice

Option The incidence ranges from approximately 10% to 30%, with most incorrect
current studies closer to the lower end of this range

Option Avoidance of valve oversizing and overinflation during deployment correct

as well as slightly lower valve placement all may be beneficial in
reducing the need for a new pacemaker

Option Younger patients are less likely to have preexisting conduction incorrect
system disease and therefore may be less likely to require a new
pacemaker

Option Patients with preexisting conduction system abnormalities are incorrect

particularly prone to develop increased conduction system block
after TAVR

Solution Answer.B

The requirement for a new, permanent pacemaker in many patients continues to be

an issue with TAVR. The incidence ranges from approximately 10% to 30%, with most
current studies closer to the lower end of this range. Patients with preexisting
conduction system abnormalities are particularly prone to develop increased
conduction system block after TAVR and thus require a new, permanent pacemaker.
This requirement may gain increasing importance as TAVR becomes more frequently
employed in younger patients with a longer life expectancy. On the other hand,
 younger patients are less likely to have preexisting conduction system disease and
therefore may be less likely to require a new pacemaker. Avoidance of valve
oversizing and overinflation during deployment as well as slightly higher valve
placement all may be beneficial in reducing the need for a new pacemaker.

Marks 4 1

Question The initial size of the Inoue balloon is based on

Type multiple_choice

Option Patients weight incorrect

Option Patient's height correct

Option Severity of mitral stenosis incorrect

Option Amount of MR already present with MS incorrect

Solution Answer. B

The Inoue technique has mostly replaced the double-balloon technique, in part
because there is no risk of LV perforation with the Inoue balloon. The initial size of the
Inoue balloon is based on patient's height.

Marks 4 1

Question The most common complication from BMV is

Type multiple_choice

Option Bleeding incorrect

Option Residual atrial septal defect incorrect

Option Severe MR correct

Option Pericardial tamponade incorrect

Solution Answer. C

The most common complication from MBV, severe MR, occurs in 2% to 10% of
patients, with no significant difference between the Inoue and double-balloon
techniques. Overall procedural mortality is approximately 1%. Other, less common
procedural complications include pericardial tamponade, embolic events, vascular
complications, arrhythmias, bleeding, stroke, myocardial infarction, residual atrial
septal defect, and LV perforation

Marks 4 1

Question MitraClip works on the principle of

Type multiple_choice

Option Commissure fusion incorrect

Option Davidson technique incorrect

Option Judgkins techniue incorrect

Option Alferi technique correct

Solution Answer. D

MitraClip (Abbott Vascular) was the first transcatheter mitral valve repair technology
to receive CE (Conformité Européenne) Mark approval (European Union) and has now
also received limited FDA approval for patients with primary (degenerative) MR and
prohibitive surgical risk. This system replicates the Alfieri stitch operation, in which
the middle scallops of the posterior and anterior leaflets (P2 and A2, respectively) are
sutured together to create a double-orifice mitral valve.

Marks 4 1

Question Trial with MitraClip

Type multiple_choice

Option ACCENT incorrect

Option EVEREST correct

Option PARTNER incorrect

Option TITAN incorrect

Solution Answer. B

Trials with MitraClip have confirmed its feasibility (e.g., Endovascular Valve Edge-to-
Edge Repair Study [EVEREST] I), and its safety and efficacy were compared with those
of surgical repair in a randomized trial (EVEREST II).

Marks 4 1

Question Trial conducted on MitralClip in secondary MR is

Type multiple_choice

Option EVEREST I incorrect

Option EVEREST II incorrect

Option TITAN incorrect

Option COAPT correct

Solution Answer. D

In addition to improved symptoms, a 50% to 70% reduction in hospitalization for

heart failure in the year after versus the year before MitraClip implantation has been
observed, prompting a randomized trial, COAPT (Clinical Outcomes Assessment of the
MitraClip Percutaneous Therapy for High Surgical Risk Patients), to compare the
device with medical therapy in patients with secondary MR.

Marks 4 1
Question Cardiac vein in proximity to the posterior mitral annulus is

Type multiple_choice

Option Small cardiac vein incorrect

Option Coronary sinus incorrect

Option Grater cardiac vein correct

Option Anterior cardiacvein incorrect

Solution Answer. C

The venous anatomy of the heart is of particular interest for treating MR because of
the ease of access (from the right internal jugular vein) and the location of the great
cardiac vein in proximity to the posterior mitral annulus.

Marks 4 1

Question Mitraglin works on principle of

Type multiple_choice

Option Cerclage annuloplasty technique incorrect

Option Paneth's posterior suture plication correct

Option Alfieri stitch technique incorrect

Option Tendyne Repair incorrect

Solution Answer. B

The Mitralign Percutaneous Annuloplasty System (Mitralign) was originally based on

the surgical techniques of Paneth's posterior suture plication.

Marks 4 1
Question Millipede are used for

Type multiple_choice

Option MR incorrect

Option TR correct

Option AR incorrect

Option PR incorrect

Solution Answer. B

Several companies are developing analogs of ring annuloplasty placed directly on the
valve (Millipede) or implanted externally via the pericardial space (Triapta).
Additionally, caval valve implants with current TAVR devices and novel devices
specifically designed for this purpose (Tric Valve) are under evaluation.

Marks 4 1