MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND MORPHOLOGY OF REGURGITANT MITRAL-VALVES IN SURGICAL REPAIR

Backgrounds: An essential step in the surgical management of patients with mitral regurgitation, is a thorough understanding of the pathophy siological mechanism. This information can be obtained by multiplane t ransoesophageal echocardiography which displays all the components of thee incompetent valve. Methods and results: Forty-nine patients were scanned intra-operatively by, multiplane transoesophageal echocardiogr aphy, and findings compared with those at visual inspection during sur gery. The pre-operative diagnosis was prolapse of the anterior mitral leaflet in nine patients (sensitivity 100%, specificity 95%), prolapse of the posterior leaflet in 17 patients (sensitivity 100%, specificit y 94%) and prolapse of both leaflets in eight patients (Sensitivity 87 %, specificity 100%). In II patients annular dilatation with no abnorm alities in mitral leaflet closure or motion was diagnosed (sensitivity 73%, specificity 100%), Two patients had a false-positive diagnosis o f prolapse of the anterior leaflet, two others on the posterior leafle t. A prolapse of both leaflets was overlooked in one patient. Multipla ne transoesophageal echocardiography scanned the mitral valve, disclos ing the extent of pathology along the closure line of leaflets in 88% of patients with mitral valve prolapse. The antero-posterior diameter of the mitral annulus was measured: a diameter over 35 mm indicated an nular dilatation. Using this criterion, sensitivity was 89% and specif icity 100%. Conclusions: Multiplane transoesophageal echocardiography enabled components of the mitral valve to be examined systematically, and provided important information on the pathophysiological mechanism of mitral regurgitation before surgical repair. The method also allow ed the surgical outcome to be assessed offering the possibility of opt imal repair.