title: Real-time three-dimensional transesophageal echocardiography to predict artificial chordae length for mitral valve repair.
abstract: BACKGROUND
  Artificial chordae replacement is an effective technique for mitral valve repair, however, it is difficult to accurately determine the length of artificial chordae. This study aimed to assess the reliability and accuracy of real-time three-dimensional transesophageal echocardiography (TEE) to predict the length of artificial chordae preoperatively.
  
  
  METHODS
  From December 2008 to December 2010, 48 patients with severe mitral regurgitation successfully underwent mitral valve repair using artificial chordae replacement. The patients were divided into a TEE pre-measurement group (n = 26) and a direct measurement group (n = 22), according to the method used to determine the length of artificial chordae. Cardiopulmonary bypass time, aortic cross-clamp time, and the recurrence rate of moderate or severe mitral regurgitation were compared between the two groups.
  
  
  RESULTS
  There were no operative deaths in either group. The mean cardiopulmonary bypass time was 113.0 ± 18.7 min and 127.0 ± 28.9 min (p < 0.05), and the aortic cross-clamp time was 70.0 ± 16.6 min and 86.0 ± 20.7 min (p < 0.05) in the TEE pre-measurement group and direct measurement group, respectively. The difference between the pre-measured artificial chordal length and actual constructed artificial chordal length was not significant in the TEE pre-measurement group (p > 0.05). Although the difference in the incidence of moderate or severe mitral regurgitation between the two groups was not significant (p > 0.05), the incidence in the TEE pre-measurement group (3.8%) was lower than that in the direct measurement group (18.2%).
  
  
  CONCLUSIONS
  Real-time three-dimensional transesophageal echocardiography can accurately predict the length of artificial chordae required for mitral valve repair, and shortens cardiopulmonary bypass time and aortic cross-clamp time while improving the results of mitral valve repair.
authors.affiliation: The Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Dongchuan Road, Guangzhou 510100, China.
authors.forename: Huan-lei
authors.initials: HL
authors.lastname: Huang
authors.forename: Xu-jing
authors.initials: XJ
authors.lastname: Xie
authors.forename: Hong-wen
authors.initials: HW
authors.lastname: Fei
authors.forename: Xue-jun
authors.initials: XJ
authors.lastname: Xiao
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Jian
authors.initials: J
authors.lastname: Zhuang
authors.forename: Cong
authors.initials: C
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D002648:Child; D002815:Chordae Tendineae / Q000000981:diagnostic imaging* / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D061646:Operative Time; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results