Value of transesophageal dobutamine stress echocardiography for selection of the type of cardiac surgery in significant ischaemic mitral insufficiency.
BACKGROUND
Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy.


OBJECTIVE
To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus.


METHODS
The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery.


RESULTS
In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0.


CONCLUSIONS
TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.
Kochanowski
Janusz
J
I Katedra i Klinika Kardiologii AM, ul. Banacha 1a, 02-097 Warszawa. jkochanowski@amwaw.edu.pl
Scisło
Piotr
P
Kosior
Dariusz A
DA
Suwalski
Piotr
P
Piatkowski
Radosław
R
Kurowski
Andrzej
A
Suwalski
Kazimierz B
KB
Opolski
Grzegorz
G
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D025401:Echocardiography, Stress / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications* / Q000601:surgery; D018570:Risk Assessment; D016896:Treatment Outcome