IMPROVED EVALUATION OF PROSTHETIC VALVE R EGURGITATION BY MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

To study the value of the newly introduced multiplane transesophageal transducer technology for the assessment of prosthetic valve regurgita tion, 63 consecutive patients with 35 mitral and 33 aortic prostheses (23 bioprostheses and 45 mechanical prostheses) were examined. Transva lvular, paravalvuIar, and, in mechanical valves, normal or pathologica l transvalvular regurgitation were identified using first 0 degrees (t ransverse) and 90 degrees (longitudinal) planes combined with flexion of the echoscope tip and then additionally using multiple intermediary planes by transducer rotation. In a subgroup of 20 patients interobse rver variability was evaluated. Both methods showed regurgitation in 5 6/58 valves; one additional case of regurgitation was seen by multipla ne imaging only. However, there were 19 cases of regurgitation not cle arly classifiable by biplane technique compared to only three using mu ltiplane technique. Grading of severity was concordant by both modalit ies in 66 and discordant in only two cases. Observers disagreed on sev erity in 2/20 cases based on biplane imaging, but in none based on mul tiplane imaging; classification of regurgitation differed in 6/20 bipl ane and 1/20 multiplane images respectively. Conclusion: Multiplane tr ansesophageal imaging improves classification of prosthetic regurgitat ion, but has Little effect on severity grading.