R. Enriquez-sarano et al., Functional anatomy of mitral regurgitation - Accuracy and outcome implications of transesophageal echocardiography, J AM COL C, 34(4), 1999, pp. 1129-1136
Citations number
46
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES This study was performed to determine the accuracy and outcome i
mplications of mitral regurgitant lesions assessed by echocardiography.
BACKGROUND In patients with mitral regurgitation (MR), valve repair is a ma
jor incentive to early surgery and is decided on the basis of the anatomic
mitral lesions. These lesions can be observed easily with transesophageal e
chocardiography (TEE), but the accuracy and implications for outcome and cl
inical decision-making of these observations are unknown.
METHODS In 248 consecutive patients operated on for MR, the anatomic lesion
s diagnosed with TEE were compared with those observed by the surgeon and t
hose seen on 216 transthoracic echocardiographic (TTE) studies, and their r
elationship to postoperative outcome was determined.
RESULTS Compared with surgical diagnosis, the accuracy of TEE was high: 99%
for cause and mechanism, presence of vegetations and prolapsed or flail se
gment, and 88% for ruptured chordae. Diagnostic accuracy was higher for TEE
than TTE for all end points (p < 0.001), but the difference was of low mag
nitude (<10%) except for mediocre TTE imaging or flail leaflets (both p < 0
.001). The type of mitral lesions identified by TEE (floppy valve, restrict
ed motion, functional lesion) were determinants of valve repairability and
postoperative outcome (operative mortality and long-term survival; all p =
0.001) independent of age, gender, ejection fraction and presence of corona
ry artery disease.
CONCLUSIONS Transesophageal echocardiography provides a highly accurate ana
tomic assessment of all types of MR lesions and has incremental diagnostic
value if TTE is inconclusive. The functional anatomy of MR defined by TEE i
s strongly and independently predictive of valve repairability and postoper
ative outcome. Therefore, the mitral lesions assessed by echocardiography r
epresent essential information for clinical decision making, particularly f
or the indication of early surgery fbr MR. (J Am Coll Cardiol 1999;34:1129-
36) (C) 1999 by the American College of Cardiology.