ADDITIONAL VALUE OF BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN ASSESSING THE GENESIS OF MITRAL REGURGITATION AND THE FEASIBILITY OF VALVE REPAIR

To determine the additional diagnostic value of biplane transesophagea l echocardiography (TEE) in patients undergoing mitral valve surgery, we studied 48 patients with severe mitral regurgitation. Transesophage al echocardiographic video recordings were reorganized in separate tra nsverse and longitudinal sections to allow independent evaluation. Mec hanism of mitral regurgitation and anatomic abnormalities of the mitra l valve were assessed by all 3 transesophageal echocardiographic modal ities and were related to surgical findings. Biplane TEE detected incr eased leaflet mobility with a sensitivity of 91% and a specificity of 84%, and restricted leaflet mobility with a sensitivity of 100% and a specificity of 97%. Biplane TEE was accurate in the diagnosis of most of the anatomic abnormalities associated with these mechanisms. Howeve r, the sensitivity for detecting subvalvular abnormalities (including papillary muscle abnormalities) was poor, and measurement of the annul ar diameter had a poor correlation with annular dilatation. Although t he yield of biplane TEE was better than either transverse or longitudi nal TEE alone, the differences did not reach statistical significance, because of the size of the patient group. The surgical procedure (eit her valve repair or replacement) was correctly predicted with transver se TEE in 71%, with longitudinal TEE in 69%, and with biplane TEE in 7 9% of the patients. All 3 transesophageal echocardiographic modalities are very of assessing the anatomic abnormalities and mechanism of mit ral regurgitation, as well as predicting the feasibility of valve repa ir.