CMS 2012 Paper Solutions - 2

Q4. Answer - (d)

American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for Mitral Valvuloplasty.

  • Perform PMBV for patients (symptomatic) with severe mitral stenosis (MVA < 1.5 cm2), favorable valve morphology and absence of contraindications such as left atrial thrombus or significant mitral regurgitation (Class I).
  • Asymptomatic patients with MVA < 1.5 cm2, pulmonary hypertension (systolic pulmonary pressure >50 mm Hg at rest or >60 mm Hg with exercise), and favorable valve morphology should also be considered for PMBV (Class I).
  • Patients with calcific mitral stenosis who are at high risk for surgical commissurotomy should be considered for PMBV when advanced heart failure (NYHA Class III-IV) and severe mitral stenosis (MVA < 1.5 cm2) are present (Class IIa).
  • Similar patients who are at lower risk for surgical commissurotomy may also be considered for PMBV (Class IIb).
  • Symptomatic patients (NYHA class II-IV) with milder stenosis (MVA >1.5 cm2) and pulmonary hypertension may be considered for PMBV (Class IIb).
  • Asymptomatic patients with MVA less than 1.5 cm2 with new atrial fibrillation may also be considered for PMBV (Class IIb).

Q5. Answer – (a)

Q6.  Answer – (c)

Q7. Answer- (c) 

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