ACCURATE LOCALIZATION OF MITRAL REGURGITANT DEFECTS USING MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Background. Appropriate patient selection for surgical repair of the m itral valve depends on the specific location and mechanism of regurgit ation, which, in turn, has necessitated a more detailed method to accu rately describe mitral pathology. This study tests a strategy of using multiplane transesophageal echocardiography to systematically localiz e mitral regurgitant defects and compares these results with the surgi cal findings. Methods. Fifty patients with mitral regurgitation underw ent intraoperative transesophageal echocardiography for the evaluation of mitral pathology and potential repair. Mitral regurgitant defects were localized using a systematic strategy and a simple nomenclature t hat divides each mitral valve into six sections (three sections per le aflet) and each prosthetic sewing ring into six sections (60 radial de grees = one section). Results. Thirty-nine patients with native mitral valves were studied, for a total of 234 sections evaluated. Eighty-se ven of these sections contained regurgitant defects by transesophageal echocardiography (mean number of regurgitant defects per valve, 2.2; range, 1 through 6). There was agreement between the transesophageal e chocardiographic and surgical localizations in 96% (224/234; p < 0.000 1) of the sections. Eleven patients with prosthetic mitral valves were studied, for a total of 66 sections evaluated. Twenty-three of these sections contained paravalvular leaks by transesophageal echocardiogra phy (mean number of leaks per prosthesis, 2.1; range, 1 through 6). Th ere was agreement between the transesophageal echocardiographic and su rgical localizations in 88% (58/66; p < 0.001) of the sections. Conclu sions. This transesophageal echocardiographic strategy provides a syst ematic method to accurately localize mitral regurgitant lesions and ha s the potential to improve the preoperative assessment of patients wit h significant mitral regurgitation. (C) 1998 by The Society of Thoraci c Surgeons.