title: Morphologic characterization and quantitative assessment of mitral regurgitation with ruptured chordae tendineae by transesophageal echocardiography.
abstract: To compare the accuracy of transesophageal echocardiography (TEE) with that of transthoracic echocardiography (TTE) in the detection of morphologic characteristics and in the quantitative assessment of the severity of mitral regurgitation with ruptured chordae tendineae, 40 patients with ruptured chordae tendineae (group 1) and 20 patients with moderate or severe mitral regurgitation due to other causes (group 2) were studied. All echocardiograms were recorded before cardiac surgery. Cardiac catheterization was performed in 55 patients (92%). TEE showed greater sensitivity and negative predictive value than TTE (100 vs 65%, and 100 vs 56%, respectively; p < 0.005) in the diagnosis of ruptured chordae tendineae. Visualization of the ruptured chordae (termed snake-tongue sign) was highly sensitive and specific (93 and 95%, respectively) for establishing the diagnosis of ruptured chordae tendineae. The severity of mitral regurgitation in group 1 patients evaluated by TTE color flow mapping was underestimated by 2 grades in 1 patient and by 1 grade in 6 patients, and overestimated by 1 grade in 1 patient, compared with left ventriculography. In contrast, by TEE color flow mapping it was underestimated by 1 grade in 1 and overestimated by 1 grade in 1 patient. TEE color flow mapping showed better correlation with angiography than did TTE color flow mapping (r = 0.82 vs r = 0.49).
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
authors.forename: K G
authors.initials: KG
authors.lastname: Shyu
authors.forename: M H
authors.initials: MH
authors.lastname: Lei
authors.forename: J J
authors.initials: JJ
authors.lastname: Hwang
authors.forename: S C
authors.initials: SC
authors.lastname: Lin
authors.forename: P
authors.initials: P
authors.lastname: Kuan
authors.forename: W P
authors.initials: WP
authors.lastname: Lien
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002815:Chordae Tendineae / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler / Q000379:methods; D004947:Esophagus; D005260:Female; D006341:Heart Rupture / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013909:Thorax