Intraoperative assessment of mitral regurgitation: role of phenylephrine challenge.
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.
Mihalatos
Dennis G
DG
St Francis Hospital-The Heart Center/Stony Brook University Hospital, Roslyn, New York 11576, USA. dgmecho@yahoo.com
Gopal
Aasha S
AS
Kates
Robert
R
Toole
Rena S
RS
Bercow
Neil R
NR
Lamendola
Christopher
C
Berkay
Sinan H
SH
Damus
Paul
P
Robinson
Newell
N
Grimson
Roger
R
Shen
Kevin
K
Reichek
Nathaniel
N
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
D014662:Vasoconstrictor Agents; D010656:Phenylephrine