MORPHOLOGIC CHARACTERIZATION AND ASSESSMENT OF MITRAL REGURGITATION AFTER REPAIR OF ATRIOVENTRICULAR DEFECTS IN CHILDREN

Severe postoperative mitral regurgitation renders information on the u nderlying mechanism before reoperation very important, as a potential for mitral valve reconstruction may facilitate the decision whether to reoperate, especially in the very young. This study compares the effi cacy of transthoracic echocardiography (TTE) and left-ventricular angi ography with that of transesophageal echocardiography (TEE) for detect ion of the mechanism underlying mitral regurgitation and its quantitat ive assessment in children after repair of common atrioventricular sep tal defect. Five children aged 1.5 to 16 years were evaluated by TTE, TEE, and angiography for postoperative mitral regurgitation 1 to 21 mo nths after initial repair. TEE showed septal detachment of the mitral leaflet in four patients and reopening of the mitral cleft in one pati ent as the cause of mitral regurgitation whereas TTE failed in four an d angiography In all patients. TEE allows definite Identification of m orphologic characteristics of mitral regurgitation and reliable assess ment of its severity. Thus redo surgery may be safely performed on the bases of TEE findings alone without confirmation by cardiac catheteri zation.