TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CANDIDATES FOR PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Prior to percutaneous balloon mitral valvuloplasty (PBMV), mitral valv e morphology and the presence of left atrial thrombi are usually evalu ated by transthoracic two-dimensional and Doppler echocardiography (TT E). This study analyzes the impact of transesophageal echocardiography (TEE) in addition to TTE on the selection of candidates considered fo r PBMV for mitral stenosis. Seventy-five patients with severe mitral s tenosis who were considered as appropriate candidates for PBMV based o n TTE findings were studied. In 19 (25%) patients, TEE revealed findin gs that were essential for PBMV but were missed by TTE: left atrial th rombi (n = 14; including 13 in left atrial appendage), right atrial th rombus (n = 1), incomplete cor triatriatum (n = 1) and mitral valve ve getation (n = 1). In two other patients, a left atrial thrombus had be en suspected by TTE but could be excluded by TEE. TEE and TTE revealed similar scores of thickening, calcification, and mobility of the mitr al valve. Compared to TTE, thickening of the subvalvular apparatus was graded lower using horizontal plane TEE due to shadowing by the mitra l valve (echo score 1.8 +/- 0.8 vs 1.4 +/- 0.7; P < 0.05) whereas resu lts from longitudinal plane TEE were similar to TTE findings. The data show that due to the high prevalence of left atrial thrombi, TEE shou ld be performed in addition to TTE in all patients prior to PBMV.