A 21-year-old man presents to your office for evaluation. He tells you that a murmur was noted a few days after birth. He is presently asymptomatic. On examination, he is normotensive. Pulse is 65 bpm and regular. Carotid upstrokes are normal. Chest is clear. Cardiac examination reveals a nondisplaced PMI. An RV lift is present. A systolic thrill is present in the suprasternal notch. A highpitched sound is heard after S1 . A crescendo–decrescendo systolic murmur is heard at the left second intercostal space. A2 is normal.
If intervention is recommended, what is the preferred treatment approach?
Percutaneous valvuloplasty. This is the preferred treatment for young adults with pulmonic stenosis.
In the setting of AS with moderate insufficiency, which of the following methods would provide the most accurate estimate of aortic valve narrowing?
Doppler echocardiography, using the continuity equation. With significant insufficiency, the Gorlin formula becomes less reliable. Pressure half-time is not used to calculate aortic valve area, but does give a clue to the severity of the AI.
Which of the following valves has the lowest incidence of endocarditis?
Aortic homograft. Mechanical and bioprosthetic valves have a similar incidence of endocarditis, which is higher than that seen for homografts. In the setting of acute bacterial endocarditis of a prosthetic aortic valve, homografts are the valve of first choice when surgery is indicated.
What is the most common cause of TR in an adult population?
Pulmonary hypertension resulting from primary left-sided disease. The most common cause of tricuspid insufficiency is pulmonary hypertension that results from primary pathology on the left side of the heart. This includes aortic and mitral valvular diseases, as well as LV dysfunction from coronary artery disease or other cardiomyopathies.
The most common organism seen in native valve endocarditis is what?
Streptococcus viridans accounts for up to 50% of cases. Staphylococcus aureus is the next most common pathogen.