title: Three-dimensional transesophageal echocardiography for determination of the mitral valve area after mitral valve repair surgery for mitral stenosis.
abstract: BACKGROUND
  Pressure half-time (PHT) method is usually unreliable for accurate determination of mitral valve area (MVA) immediately after surgical intervention of mitral stenosis (MS). The planimetry method using three-dimensional (3D) transesophageal echocardiography (3D-planimetery method) could enhance accurate determination of the intraoperative MVA. Authors investigated the efficacy of 3D-planimetry method in determining MVA immediately after mitral valve repair procedure (MVRep) for severe mitral stenosis (MS).
  
  
  METHODS
  In severe MS patients undergoing elective MVRep (N.=41), intraoperative MVAs were determined by using PHT-method and 3D-planimetry method before and immediately after cardiopulmonary bypass (pre- and post-MVAPHT, and -MVA3D-planimetry). MVAs were also determined by using multi-detector computed tomographic scan (MDCT) before MVRep and within 7 days after MVRep (pre- and post-MVACT). MVAs determined by using three different methods were analysed.
  
  
  RESULTS
  Mitral inflow pressure gradient (median [25th-75th percentile]) was significantly reduced after MVRep (3.0 [2.0-4.0] vs. 7.0 [6.0-9.0] mmHg; P<0.001). Pre-MVAPHT, pre-MVA3D-planimetry and preop-MVACT (mean [95% confidence interval]) did not differ significantly (1.08 [1.00-1.05], 1.08 [0.98-1.08], and 1.14 [1.07-1.22] cm2, respectively), but post-MVA3D-planimetry and post-MVACT (2.22 [2.07-2.36] and 2.31 [2.07-2.36] cm2, respectively) were significantly larger than post-MVAPHT (1.98 [1.83-2.13] cm2; P=0.007 and P<0.001, respectively). The correlation coefficient between post-MVA3D-planimetry and post-MVACT (0.59, P<0.01) was greater than that between post-MVAPHT and post-MVACT (0.39, P=0.01).
  
  
  CONCLUSIONS
  These results support the clinical efficacy of 3D-planimetry for accurate evaluation of the MVA immediately after MVRep for severe MS, as a valuable alternative to PHT-method which usually underestimates MVA during this period.
authors.affiliation: Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea - taeyop@gmail.com.
authors.forename: Woon S
authors.initials: WS
authors.lastname: Kang
authors.forename: Sung M
authors.initials: SM
authors.lastname: Ko
authors.forename: Younsuk
authors.initials: Y
authors.lastname: Lee
authors.forename: Chung S
authors.initials: CS
authors.lastname: Oh
authors.forename: Mi Y
authors.initials: MY
authors.lastname: Kwon
authors.forename: Hasmizy
authors.initials: H
authors.lastname: Muhammad
authors.forename: Seong H
authors.initials: SH
authors.lastname: Kim
authors.forename: Tae Y
authors.initials: TY
authors.lastname: Kim
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome