Functional anatomy of aortic regurgitation. Role of transesophageal echocardiography in aortic valve-sparing surgery.
OBJECTIVE
The aim was to evaluate the usefulness of transesophageal echocardiography (TEE) for the preoperative functional anatomical assessment of patients with aortic regurgitation (AR) to identify those eligible for valve-sparing surgery (VSS).


METHODS
We determined the accuracy and diagnostic value of TEE for identifying underlying lesions and mechanisms in 66 patients who underwent surgery for severe AR by comparing TEE findings with those obtained on surgical inspection. The usefulness of TEE for predicting the feasibility of VSS was determined.


RESULTS
The overall diagnostic accuracy of TEE was excellent (87%, kappa=0.82), with valve prolapse being the principle cause of discrepancy between the methods (in 23/27 cases; 85%). Three anatomical forms of dilatation of the ascending aorta (AA) were correctly classified (accuracy >88%; kappa 0.83): supratubal aneurysm (19 patients), aortic root aneurysm (4), and annuloaortic ectasia (24). The mechanism underlying AR was identified with an accuracy of 85% (kappa 0.8) and there was a significant association between the type of mechanism identified by TEE and the success of VSS (P< .001): VSS was successful in 73% of patients with dilatation of a functional annulus (i.e. with tethering), but aortic valve replacement was required in 78% with prolapses, 90% with thickened leaflets with restricted movement, and 100% with perforation. There was also a relationship between the type of aneurysm and the technique required for AA replacement (P=.004).


CONCLUSIONS
Use of TEE enabled the mechanism underlying AR to be accurately identified. There was a high level of agreement with surgical inspection and the technique was useful for predicting the feasibility of VSS and the surgical procedure for AA replacement.
Gallego García de Vinuesa
Pastora
P
Hospital Universitario Virgen Macarena, Sevilla, Spain. pastoragallego@teleline.es
Castro
Antonio
A
Barquero
José Miguel
JM
Araji
Omar
O
Brunstein
Gerardo
G
Méndez
Irene
I
Infantes
Carlos
C
Cruz-Fernández
José María
JM
D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D006801:Humans; D011237:Predictive Value of Tests; D015203:Reproducibility of Results