Trial Written Exam April 2023

Section 9: 1 Question. 10 minutes

Two part question. After completing this section you will receive the password for Section 10

75M referred by cardiologist for repair of mitral valve for severe MR and mod AR. Reports worsening SOBOE over last 6 months. Also reporting some peripheral oedema.

Past History:

  • EVAR AAA repair

  • PVD

  • Chronic AF – on apixaban

  • Ex-smoker

  • Hypertension

Social History

  • From home with wife. Mobilises well without aids

Angiogram:

  • LHC normal, RCA dominant with no disease, large calibre LAD, LCx no disease

TTE

  • Normal LV Function

  • Severe MR with posteriorly directed jet

TOE

  • Moderate-Severe MR posteriorly directed jet

  • Moderate AR

  • Mild TR – Annulus 38mm

  • Ascending aorta diameter 45mm, aortic root 45mm, LVOT diameter 29mm

CTA chest

  • SoV 4.5 x 4.4cm

  • STJ 3.5 x 4.1cm

  • Mid asc 4.1 x 4.1cm

  • BCA Asc Ao 4.5 x 4cm

  • Moderate scattered calcified thoracic aortic atherosclerosis; no dissection or penetrating aortic ulcer

  • Bilateral calcified and non-calcified pleural plaques noted

  • Mild-mod cardiomegaly

  • EVAR repair noted below the level of the renal arteries – heavily diseased femoral arteries