Evaluation of mitral valve repair by intraoperative transoesophageal echocardiography

J. M. Kalman, B. B. Buxton, E. F. Jones, A. M. Tonkin, S. Lubicz, P. Calafiore

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Abstract

Background: Mitral valve repair is the procedure of choice in the surgical management of mitral regurgitation. Intraoperative confirmation of successful repair is essential to the effectiveness of this procedure. Aims: The aims of this study were: (a) to compare intraoperative transoesophageal echocardiography (TOE) with the surgeon's assessment of valve competence; (b) to assess the impact of routine intraoperative imaging on the hospital echocardiography laboratory. Methods: Eighty‐six consecutive patients undergoing mitral valve repair formed the study population. Valve competence following repair was assessed intraoperatively by: TOE; saline insufflation of the flaccid left ventricle; and evaluation of the pulmonary capillary wedge pressure for the presence of a significant V wave. Results: TOE demonstrated successful valve repair (≤ 1 + residual regurgitation) in 75 patients (87%) and detected significant residual regurgitation (≥3 +) in seven (8.2%). The mechanism of regurgitation was also clearly shown. Of these seven patients, four underwent immediate valve replacement, two had successful revision of the initial repair and one required valve replacement one week later. In all seven patients the valve repair had been assessed as successful by saline testing and only one had a post‐repair V wave 10 mmHg above the mean pulmonary capillary wedge pressure. In 30 non‐selected patients the imaging equipment was required in theatre for 43 ± 18 minutes. Conclusions: TOE is currently the most sensitive method for detection and quantitation of residual mitral regurgitation following valve repair. Evaluation can be performed within a similar time to that required for one complete transthoracic study and can usually be performed with minimal disruption to the hospital echocardiography laboratory. (Aust NZ J Med 1993; 23: 463–469.)

Original languageEnglish
Pages (from-to)463-469
Number of pages7
JournalAustralian and New Zealand Journal of Medicine
Volume23
Issue number5
DOIs
Publication statusPublished - Oct 1993
Externally publishedYes

Keywords

  • Mitral regurgitation
  • mitral valve repair
  • transoesophageal echocardiography

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