VALUE OF SYSTOLIC PULMONARY VENOUS FLOW REVERSAL AND COLOR DOPPLER JET MEASUREMENTS ASSESSED WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN RECOGNIZING SEVERE PURE MITRAL REGURGITATION

We evaluated the value of color and pulsed Doppler transesophageal ech ocardiographic parameters and of V waves in estimating the severity of mitral regurgitation (MR) in 62 consecutive patients (38 men and 24 w omen, aged 39 to 80 years) with angiographically proven chronic pure M R (15 grade I/II, 47 grade III/IV). Twenty patients were examined befo re cardiac surgery under general anesthesia. Sensitivity, specificity, and positive and negative predictive values of systolic pulmonary ven ous flow reversal for the presence of grade III/IV MR were 87%, 93%, 9 8%, and 64%, respectively; these were for jet areas greater than or eq ual to 8.0 cm(2)-66%, 100%, 100%, and 48%, for jet lengths greater tha n or equal to 50 mm-70%, 87%, 94%, and 48%, for enlarged V waves-86%, 38%, 83%, and 43%, and for either flow reversal or a let urea greater than or equal to 8.0 cm(2)-96%, 93%, 98%, and 88%. We conclude that a combination of measurements improved the negative predictive value con siderably, which is of importance in a population with a high pretest probability of severe MR. Enlarged V waves are not reliable in predict ing severe MR. The optimal cutoff value for let area and let length wa s lower in anesthesized patients than in conscious patients; in anesth esized patients, sensitivity, specificity, and positive and negative p redictive values of let area greater than or equal to 5.0 cm(2) for gr ade III/IV MR were 67%, 100%, 100%, and 50%, respectively; these were 87%, 100%, 100%, and 71% for flow reversal. Because the results of mit ral repair are often evaluated with transesophageal echocardiography d uring surgery, our findings have clinical implications for evaluation of severe MR in anesthesized patients: pulmonary venous flow direction is the first-choice measure; jet area can be used when a low cutoff p oint is chosen.