USEFULNESS OF MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO IMPROVE THE ASSESSMENT OF SEVERITY OF MITRAL REGURGITATION

This study was designed to examine the accuracy of multiplane transeso phageal echocardiography (TEE) color Doppler measurements in compariso n to monoplane or biplane measurements in estimating the severity of m itral regurgitation (MR). Multiplane TEE potentially increases diagnos tic accuracy of transesophageal examinations; it is unknown if multipl ane is more accurate in assessing the severity of MR than monoplane or biplane TEE. Left ventricular cineangiograms of 91 patients with MR ( 40 no or mild, 30 moderate, and 21 severe) were compared with systolic pulmonary venous flow reversal and transesophageal color Doppler meas urements: jet area and length in the transverse and longitudinal plane , maximal and average of those 2 planes (biplane), and maximal and ave rage of 11 different planes (multiplane). Flow reversal (16 patients) identified severe MR with a specificity of 96% and a sensitivity of 62 %; these were 96% and only 10% to 43%, respectively, for color Doppler measurements. in the absence of flow reversal, multiplane maximal jet area predicted severe MR with a sensitivity of 88% and a specificity of 75%, which were 85% and 76%, respectively, for no or mild MR; this did not differ significantly from results obtained by monoplane or bip lane measurements. Color Doppler measurements of eccentric jets were n ot reliable for identification of severe MR. Systolic pulmonary venous flow reversal identifies 2 of 3 patients with severe MR with a high a ccuracy. In patients without flow reversal, multiplane color Doppler T EE is very capable of assessing MR severity, but biplane and monoplane TEE are equally accurate. (C) 1996 by Excerpta Medica, Inc.