VALUE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE FOLLOW-UP OF SUCCESSFUL PERCUTANEOUS MITRAL COMMISSUROTOMY

This study was undertaken to determine the value of transoesophageal e chocardiography in the follow-up of patients with severe mitral stenos is having undergone successful percutaneous mitral commissurotomy as d efined as a final valve surface area > 1,5 cm2 without > 2/4 mitral re gurgitation (MR). Eighty one patients who had undergone successful pro cedures were studied by transthoracic (TTE) and transoesophageal echoc ardiography (TOE) before, immediately after (24 to 48 hours) and at me dium term (8 +/- 4 months) after balloon commissurotomy. The three mai n parameters studied were the degree of MR, presence of inter-atrial s hunt and spontaneous left atrial contrast. Immediately after commissur otomy the MR was graded 0/4 in 6 patients (7,5 %), 1/4 in 48 patients (59 %) and 2/4 in 27 patients (33,5 %). The TOE showed small traumatic lesions (localised valve tears, rupture of an accessory chordae tendi nae) in 9 cases (11 %). At medium term follow-up, the MR was stable in 75 patients (93 %), decreased by one grade in 3 patients (3,5 %), wit hout the occurrence of severe MR. Interatrial shunts were more frequen tly observed by TOE than by TTE or oxymetry with a prevalence of 57 %. They usually disappeared at medium term follow-up. There were 3 facto rs associated with its persistence: a shunt visible at TTE, immediatel y after commissurotomy, visualisation of an atrial septal defect and a shunt jet width greater-than-or-equal-to 5 mm at TOE immediately afte r commissurotomy. Spontaneous contrast was common before the procedure (65 Medium term follow-up usually showed regression of this phenomeno n in patients in sinus rhythm (82 %) whereas it usually persisted in p atients with atrial fibrillation (82 %) but was less severe. Mitral co mmissurotomy therefore has a beneficial effect on this marker of throm boembolic risk.