VALUE OF MULTIPLANE TRANSESOPHAGEAL ECHOC ARDIOGRAPHY IN THE ASSESSMENT OF MITRAL-VALVE PROSTHESES

Many reports have confirmed the value of transoesophageal echocardiogr aphy in the diagnosis of mechanical mitral valve prosthesis dysfunctio n: new biplane and multiplane probes seem to provide additional inform ation in the assessment of cardiac disease. The aim of this study was to quantify the additional value of these new probes in the assessment of mitral valve prostheses. Seventy-five mitral valve prostheses were assessed with the multiplane probe, 45 normal bileaflet prostheses, 1 7 with regurgitant dysfunction and 12 with non obstructive thrombi and /or strands, and one with a blocked leaflet. In order to compare the r espective values of monoplane, biplane and multiplane probes, the reco rdings were performed at 0 degrees, 90 degrees and from 0 degrees to 1 80 degrees in continuous sweep mode through the scanning plane. Global ly, with the monoplane assessment, it was only possible to visualise b oth leaflets simultaneously in 13 % of cases. The majority of prosthes es was correctly analysed between 60 and 100 degrees. This was of para mount importance for the diagnosis of blockage of one leaflet. With re spect to para-prosthetic valve regurgitation, the transverse view allo wed visualisation of the lateral and paraseptal annular regions. The a ddition of a longitudinal view allowed visualisation of anterior and p osterior regurgitant jets : the supplementary views provided by the mu ltiplane probe allowed detection of small regurgitant jets in the diag onal planes between the longitudinal and transverses views. The multip lane probe offers the possibility of identifying the precise origin of the Jet and helps quantification and peroperative localisation of its position. Small, non-obstructive thrombi and strands are better seen using a multiplane probe, especially when of small size. Therefore, mu ltiplane transoesophageal echocardiography improves the assessment of mitral valve prostheses, the majority of diagnoses being, however, acc essible with biplane probes.