title: Discrepancy between intraoperative transesophageal echocardiography and postoperative transthoracic echocardiography in assessing congenital valve surgery.
abstract: BACKGROUND
  The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair.
  
  
  METHODS
  Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months).
  
  
  RESULTS
  Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 +/- 0.8 versus 1.4 +/- 0.9; p < 0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p < 0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 +/- 0.8 versus 1.1 +/- 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients.
  
  
  CONCLUSIONS
  There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.
authors.affiliation: Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kotani
authors.forename: Satoru
authors.initials: S
authors.lastname: Osaki
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Fujita
authors.forename: Takanori
authors.initials: T
authors.lastname: Suezawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tateishi
authors.forename: Kozo
authors.initials: K
authors.lastname: Ishino
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kawada
authors.forename: Teiji
authors.initials: T
authors.lastname: Akagi
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000151:congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D015588:Observer Variation; D011184:Postoperative Period; D012189:Retrospective Studies