title: Intraoperative assessment of mitral regurgitation: role of phenylephrine challenge.
abstract: OBJECTIVE
  We defined the effects of the operative (OP) state and phenylephrine challenge on the assessment of mitral regurgitation (MR) severity.
  
  
  METHODS
  In all, 57 patients underwent transesophageal echocardiographic assessment of MR severity pre-OP (PREOP) and intra-OP. MR severity was assessed PREOP under conscious sedation and intra-OP with general anesthesia, before and after hemodynamic manipulation with vasoactive agents, to match intra-OP and PREOP transesophageal echocardiographic mean arterial blood pressures.
  
  
  RESULTS
  Intra-OP MR and mean arterial pressure were less than PREOP in 27 patients (both P < .001). When PREOP and OP blood pressures were matched using phenylephrine, there was no significant difference in MR severity between the two states (P = 1.0). Nonetheless, MR severity was still underestimated in 6 patients and overestimated in 7 patients intra-OP.
  
  
  CONCLUSIONS
  Intra-OP transesophageal echocardiography underestimates MR severity. Phenylephrine reduces, yet does not eliminate, intra-OP underestimation of MR severity.
authors.affiliation: St Francis Hospital-The Heart Center/Stony Brook University Hospital, Roslyn, New York 11576, USA. dgmecho@yahoo.com
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Mihalatos
authors.forename: Aasha S
authors.initials: AS
authors.lastname: Gopal
authors.forename: Robert
authors.initials: R
authors.lastname: Kates
authors.forename: Rena S
authors.initials: RS
authors.lastname: Toole
authors.forename: Neil R
authors.initials: NR
authors.lastname: Bercow
authors.forename: Christopher
authors.initials: C
authors.lastname: Lamendola
authors.forename: Sinan H
authors.initials: SH
authors.lastname: Berkay
authors.forename: Paul
authors.initials: P
authors.lastname: Damus
authors.forename: Newell
authors.initials: N
authors.lastname: Robinson
authors.forename: Roger
authors.initials: R
authors.lastname: Grimson
authors.forename: Kevin
authors.initials: K
authors.lastname: Shen
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Reichek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D010656:Phenylephrine; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine