title: Evaluation of transmitral pressure gradients in the intraoperative echocardiographic diagnosis of mitral stenosis after mitral valve repair.
abstract: OBJECTIVE
  Acute mitral stenosis (MS) following mitral valve (MV) repair is a rare but severe complication. We hypothesize that intraoperative echocardiography can be utilized to diagnose iatrogenic MS immediately after MV repair.
  
  
  METHODS
  The medical records of 552 consecutive patients undergoing MV repair at a single institution were reviewed. Post-cardiopulmonary bypass peak and mean transmitral pressure gradients (TMPG), and pressure half time (PHT) were obtained from intraoperative transesophageal echocardiographic (TEE) examinations in each patient.
  
  
  RESULTS
  Nine patients (9/552 = 1.6%) received a reoperation for primary MS, prior to hospital discharge. Interestingly, all of these patients already showed intraoperative post-CPB mean and peak TMPGs that were significantly higher compared to values for those who did not: 10.7±4.8 mmHg vs 2.9±1.6 mmHg; p<0.0001 and 22.9±7.9 mmHg vs 7.6±3.7 mmHg; p<0.0001, respectively. However, PHT varied considerably (87±37 ms; range: 20-439 ms) within the entire population, and only weakly predicted the requirement for reoperation (113±56 vs. 87±37 ms, p = 0.034). Receiver operating characteristic curves showed strong discriminating ability for mean gradients (AUC = 0.993) and peak gradients (area under the curve, AUC = 0.996), but poor performance for PHT (AUC = 0.640). A value of ≥7 mmHg for mean, and ≥17 mmHg for peak TMPG, best separated patients who required reoperation for MS from those who did not.
  
  
  CONCLUSIONS
  Intraoperative TEE diagnosis of a peak TMPG ≥17 mmHg or mean TMPG ≥7 mmHg immediately following CPB are suggestive of clinically relevant MS after MV repair.
authors.affiliation: Department of Anesthesiology, University of Colorado Denver, Denver, Colorado, United States of America.
authors.forename: Ann K
authors.initials: AK
authors.lastname: Riegel
authors.forename: Raila
authors.initials: R
authors.lastname: Busch
authors.forename: Scott
authors.initials: S
authors.lastname: Segal
authors.forename: John A
authors.initials: JA
authors.lastname: Fox
authors.forename: Holger K
authors.initials: HK
authors.lastname: Eltzschig
authors.forename: Stanton K
authors.initials: SK
authors.lastname: Shernan
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D016343:Monitoring, Intraoperative / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies
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