title: Real-world echocardiography in patients referred for mitral valve surgery: the gap between guidelines and clinical practice.
abstract: OBJECTIVE
  Mitral regurgitation (MR) is a common disorder for which mitral valve surgery is an established therapy. Although surgical indications are clearly defined for the management of valvular heart disease, a gap exists between current guidelines and their effective application. The study aim was to provide an insight into the diagnostic information provided for cardiac surgeons before performing mitral valve surgery.
  
  
  METHODS
  The source documents and echocardiographic studies of 100 patients, referred by nine hospitals, were screened for arguments for MR severity justifying referral for surgery. Details of the documented MR mechanism, mitral annulus (MA) size, tricuspid regurgitation (TR) severity and annulus size were also noted.
  
  
  RESULTS
  According to the referring physician, MR was severe in 83% and moderate-to-severe in 17%. In the great majority of patients (98%) the MR mechanism was mentioned, although specific information on the prolapsing scallops was available in only 17% of cases. The recommended primary determinants of MR severity, vena contracta and proximal isovelocity surface area (PISA) were measured in only 22% and 31% of patients, respectively. In 94% of patients with available PISA information this was described only qualitatively. Correct image expansion using the zoom mode was performed in only 25% of these patients, and a correct adaptation of the Nyquist limit in only 6%. Tricuspid annulus measurements guiding the need for concomitant tricuspid valvuloplasty in patients with less than severe TR were reported in only 6% of patients.
  
  
  CONCLUSIONS
  These data demonstrate a clear and important gap between current guidelines and real-world practice with regards to the echocardiographic diagnostic information provided to the surgeon before performing mitral valve surgery.
authors: Lotte E
authors: LE
authors: De Groot-de Laat
authors: Ben
authors: B
authors: Ren
authors: Jackie
authors: J
authors: McGhie
authors: Frans B S
authors: FB
authors: Oei
authors: Goris Bol
authors: GB
authors: Raap
authors: J J C
authors: JJ
authors: Bogers
authors: Marcel L
authors: ML
authors: Geleijnse
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery; D020380:Needs Assessment; D009426:Netherlands; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000601:surgery