title: Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes diagnostic accuracy and outcome implications.
abstract: OBJECTIVE
  We sought to assess the value of transthoracic echocardiography (TTE) using standardized imaging planes for the functional analysis of mitral regurgitation (MR) as well as for postoperative outcome implications.
  
  
  BACKGROUND
  The feasibility of mitral valve repair is based on functional assessment of MR, mainly by transesophageal echocardiography (TEE). Considering the recent advances in TTE imaging, the incremental value of TEE in this setting needs to be re-examined.
  
  
  METHODS
  Consecutive patients (n = 279; 181 men; median age 68 years [quartiles, 61 to 74]) who underwent surgery for MR were enrolled prospectively in two tertiary care centers. The accuracy of TTE (harmonic imaging) versus TEE for functional assessment of MR was evaluated against surgical findings.
  
  
  RESULTS
  Valve repair (n = 237 patients, 85%) or replacement (n = 42) was predicted accurately by TTE in 97% of cases; TEE added significant information for only two patients. In the subgroup of degenerative MR (n = 190), agreement with surgical findings for the localization of prolapsed segments was 91% for TTE (kappa, 0.81) and 93% for TEE (kappa, 0.85) without incremental value of TEE (p = 0.40). Patients with single prolapse of the middle posterior scallop (P2) had a better postoperative outcome as compared with patients who had non-P2 lesions (p = 0.008). Furthermore, mitral replacement predicted by TTE was an independent predictor for postoperative long-term mortality (odds ratio 5.7, 95% confidence interval 1.97 to 16.4, p = 0.001).
  
  
  CONCLUSIONS
  In experienced hands, functional assessment of MR by TTE can predict accurately valve repairability and has a strong influence on postoperative outcome. Thus, in most cases preoperative TEE is not mandatory, provided intraoperative TEE is performed.
authors: Department of Cardiology, Henri Mondor Hospital, Créteil, France (Assistance Publique Hôpitaux de Paris). jeanluc.monin@free.fr
authors: Jean-Luc
authors: JL
authors: Monin
authors: Patrick
authors: P
authors: Dehant
authors: Cécile
authors: C
authors: Roiron
authors: Mehran
authors: M
authors: Monchi
authors: Jean-Yves
authors: JY
authors: Tabet
authors: Philippe
authors: P
authors: Clerc
authors: Guy
authors: G
authors: Fernandez
authors: Rémi
authors: R
authors: Houel
authors: Jérome
authors: J
authors: Garot
authors: Christophe
authors: C
authors: Chauvel
authors: Pascal
authors: P
authors: Gueret
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods / Q000592:standards; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors