[Intraoperative assessment of mitral valve plasty by transesophageal echocardiography]

Abstract

Mitral valve repair offers many advantages over prosthetic valve replacement, especially in minimizing the risk of thromboembolism. Intraoperative evaluation of residual mitral regurgitation (MR) is important in this procedure. The present study assessed the usefulness of transesophageal echocardiography (TEE) for the intraoperative assessment of residual MR in patients undergoing mitral valve repair. Intraoperative TEE was performed in 102 consecutive patients before and after mitral valve repair in the operating room. The grade of MR was evaluated according to the maximum MR jet area detected by biplane color Doppler TEE (mild: <4 cm2; moderate: 4 < or = < 7 cm2; severe : 7 cm2 < or =). After the first repair, the manual regurgitant test was performed. Excellent results with no or mild MR assessed by the manual regurgitant test were obtained in 101 patients. However, moderate or severe MR was identified in eight of these 101 (7.9%) patients by TEE after weaning from the cardiopulmonary bypass. Consequently, six of these eight patients underwent repeat mitral valve repair and two patients received prosthetic valve replacement. Satisfactory final operative results were obtained in all 101 patients. The eight patients who needed additional operative procedures followed good clinical courses in hospital. TEE 1 month after operation demonstrated no or mild MR in these eight patients. Intraoperative TEE is useful in the evaluation of residual MR after mitral valve repair. This technique provides indications for immediate additional operative procedures, and can reduce the occurrences of congestive heart failure and reoperation in the early stage after mitral valve repair.