Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic transesophageal echocardiography examination

Mitral regurgitation (MR) is a major determinant of outcome in cardiac surg ery. The location and mechanism of mitral lesions determine the approach to various repairs and their feasibility. Because of incomplete evaluations o r change in patient condition, detailed intraoperative transesophageal echo cardiography (TEE) examination of the mitral valve may be required. We hypo thesized that a systematic TEE mitral valve examination would allow precise identification of the anatomic location and mechanism of MR in patients un dergoing mitral surgery. We designed a systematic mitral valve examination consisting of six views: five-chamber, four-chamber, two-chamber anterior, two-chamber mid, two-chamber posterior and short-axis. We used this examina tion prospectively in 13 patients undergoing mitral valve surgery for sever e MR and compared the results with the surgical findings. We then retrospec tively interpreted 11 similar patients who had undergone intraoperative TEE studies before this examination. TEE correctly diagnosed the mechanism and precise location of pathology in 12 of 13 patients in the prospective grou p, but in only 6 of 10 patients in the retrospective group. TEE also correc tly identified 75 of 78 mitral segments (96%) as being normal or abnormal. In the retrospective group, only 42 of 60 segments (70%) were correctly ide ntified (P < 0.001). We conclude that this systematic TEE mitral valve exam ination improves identification of mitral segments and precise localization of pathologies and may also improve the diagnosis of the mechanism of MR. Implications: In this article, we describe how a systematic examination of the mitral valve by using transesophageal echocardiography allows identific ation of the different segments of the mitral valve, precise localization o f pathology, and helps to diagnose the mechanism of mitral regurgitation. T his is important in determining an approach to mitral valve repair and its feasibility.