BIPLANE TRANSESOPHAGEAL COLOR-FLOW DOPPLER IMAGING IN ASSESSING SEVERITY OF MITRAL REGURGITATION - INFLUENCE OF HEMODYNAMIC CIRCUMSTANCES AND MECHANISM OF REGURGITATION

Objective: To determine the value of biplane transesophageal echocardi ography in the assessment of severity of mitral regurgitation compared with left ventricular angiography. Design: Prospective study of conse cutive patients. Setting: Two university hospitals, one community hosp ital. Participants: Thirty seven patients with angiographically proven mitral regurgitation. Intervention: Transthoracic and biplane transes ophageal echocardiography. In 19 patients, transesophageal echocardiog raphy was performed during general anesthesia. Measurements and Main R esults: The largest mitral regurgitation jet area and longest jet as o btained with Doppler color-flow mapping from transthoracic and biplane transesophageal echocardiography and pulsed-Doppler pulmonary venous flow characteristics. Sensitivity and 100-minus-specificity were plott ed to constitute receiver operating characteristics (ROC) curves. Area s under ROC curve for transverse, longitudinal, and biplane jet area w ere 0.77, 0.75, and 0.81, and for jet length, 0.82, 0.84, and 0.88, re spectively; this was for biplane jet area in conscious patients; 0.99 compared with 0.72 in anesthetized patients (p < 0.05). Conclusions: B iplane measurements identified severe mitral regurgitation slightly mo re reliably than the transverse or longitudinal measurements alone. In conscious patients, jet area was an excellent test for estimating sev erity of mitral regurgitation. In anesthetized patients, a combination of biplane jet area and length and of systolic pulmonary venous flow reversal accurately predicted angiographic severity of mitral regurgit ation. In anesthetized patients, the optimal cut-off value for jet are a to distinguish between moderate and severe mitral regurgitation was lower than in conscious patients. In the total population, regardless of hemodynamic and technical variations, a combination of biplane jet area and length and of systolic pulmonary venous flow reversal accurat ely predicted the severity of mitral regurgitation. Copyright (C) 1996 by W.B. Saunders Company