Intraoperative assessment of the mitral valve: transesophageal Doppler echocardiography vs. left ventricular filling of the flaccid heart.
Several methods can be used for the intraoperative assessment of residual mitral regurgitation (MR) following reconstruction of the mitral valve. The aim of this study was to compare the reliability of two of these methods: left ventricular filling of the arrested heart with saline (LVF) and intraoperative transesophageal Doppler echocardiography (TEE). Reliability was assessed by comparing LVF and TEE to postoperative left ventricular angiography (LVA) in 27 patients. LVF, TEE and LVA grading of MR was 0-4. Correlations, as measured by the Kappa statistic, were as follows: LVF-LVA: K = 0.33 (95% confidence interval (CI): 0.06-0.59), TEE-LVA: K = 0.48 (95% CI: 0.20-0.77), LVF-TEE: K = 0.43 (95% CI: 0.20-0.67). Considering LVF and TEE as predictors of LVA gradings above 2, sensitivities were 0.4 and 0.6, respectively. Specificities were 1.0 for each method. In conclusion, we found TEE in the beating heart not to be significantly more reliable in the prediction of residual MR than LVF in the flaccid heart.
Moulijn
A C
AC
Department of Cardiopulmonary Surgery, University of Amsterdam, The Netherlands.
Smulders
Y M
YM
Koolen
J J
JJ
Voorn
W J
WJ
Visser
C A
CA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left