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Vaccination in Heart Failure — EECC MCQ

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HardGeneral CardiologyVaccination in Heart FailureEECC

A patient with a mechanical mitral valve presents with pulmonary oedema and a new high transmitral gradient. One leaflet appears immobile on transthoracic imaging, but acoustic shadowing prevents defining the mechanism. Which urgent imaging combination is most useful?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — TOE plus cinefluoroscopy of mechanical leaflet motion

The best answer is “TOE plus cinefluoroscopy of mechanical leaflet motion”. TOE evaluates thrombus, pannus, regurgitation and complications, while cinefluoroscopy directly demonstrates mechanical occluder opening and closing angles. “Exercise echocardiography plus coronary calcium scoring” is less appropriate because exercise is unsafe in acute pulmonary oedema and calcium scoring is irrelevant “Cardiac PET alone without anatomical imaging” is less appropriate because PET alone cannot define occluder mechanics “Repeat transthoracic echocardiography in three months” is less appropriate because delayed reassessment is unsafe in suspected obstructive mechanical-valve dysfunction “Right-heart catheterisation without prosthetic imaging” is less appropriate because haemodynamics alone cannot distinguish thrombus from pannus or show leaflet motion

Reference: 2025 ESC/EACTS Guidelines for valvular heart disease. https://academic.oup.com/eurheartj/article/46/44/4635/8234488