title: Comparison of the diagnostic power of transthoracic and transesophageal echocardiography to detect ruptured chordae tendineae.
abstract: Preoperative information concerning the severity and etiology of MR is very important for selecting the most appropriate surgical strategy. Ruptured chordae tendineae (RCT) are one of the most important preoperative findings. We compared the diagnostic power of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) to detect RCT in patients with MR. We studied 61 patients with MR (30 men, 31 women; mean age, 61 ± 12 years) who underwent mitral valve repair or replacement. Both TTE and TEE were performed before the operations, and the sensitivity and specificity of TTE and TEE to detect RCT were determined. In addition, other factors that influenced the detection of RCT by these two methods were investigated. At the time of an operation, RCT was confirmed in 39 of 61 cases. Transesophageal echocardiography had a higher sensitivity than TTE (74% versus 44%; P = 0.006) to detect RCT, although the specificity was not significantly different. In patients with a body mass index (BMI) > 22 (P = 0.023) or MR grade 4 (P = 0.026), TEE had a significantly higher diagnostic sensitivity than TTE, although there was no significant difference in patients with BMI < 22 or MR grade ≤ 3. In the lateral and medial segments of the mitral valve, TEE had a significantly higher diagnostic sensitivity to detect RCT than TTE (P = 0.0012), although there was no significant difference in the middle segments. There was no significant difference between TTE and TEE with respect to the sensitivity to detect RCT in myxomatous mitral valves. Although the sensitivity of TEE was higher than that of TTE to detect RCT, it was affected by BMI, MR grade, the RCT-presenting segments, and the etiology of MR.
authors.affiliation: Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Minami
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawano
authors.forename: Shiro
authors.initials: S
authors.lastname: Yamachika
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuneto
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kaneko
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Kawano
authors.forename: Shigeki
authors.initials: S
authors.lastname: Minami
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
authors.forename: Koji
authors.initials: K
authors.lastname: Maemura
mesh_terms: D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000000981:diagnostic imaging* / Q000293:injuries; D017548:Echocardiography, Transesophageal; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D055815:Young Adult