CLINICAL STUDIES
Functional anatomy of mitral regurgitation
Accuracy and outcome implications of transesophageal echocardiography
Maurice Enriquez-Sarano, MD, FACC*,
William K. Freeman, MD, FACC*,
Christophe M. Tribouilloy, MD, FACC*,
Thomas A. Orszulak, MD ,
Bijoy K. Khandheria, MD, FACC*,
James B. Seward, MD, FACC*,
Kent R. Bailey, PhD and
A. Jamil Tajik, MD, FACC*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Manuscript received December 11, 1998;
revised manuscript received April 22, 1999,
accepted June 11, 1999.
Reprint requests and correspondence: Dr. Maurice Enriquez-Sarano, Mayo Clinic, 200 First Street SW, Rochester, MN 55905., USA
OBJECTIVES
This study was performed to determine the accuracy and outcome implications of mitral regurgitant lesions assessed by echocardiography.
BACKGROUND
In patients with mitral regurgitation (MR), valve repair is a major incentive to early surgery and is decided on the basis of the anatomic mitral lesions. These lesions can be observed easily with transesophageal echocardiography (TEE), but the accuracy and implications for outcome and clinical decision-making of these observations are unknown.
METHODS
In 248 consecutive patients operated on for MR, the anatomic lesions diagnosed with TEE were compared with those observed by the surgeon and those seen on 216 transthoracic echocardiographic (TTE) studies, and their relationship to postoperative outcome was determined.
RESULTS
Compared with surgical diagnosis, the accuracy of TEE was high: 99% for cause and mechanism, presence of vegetations and prolapsed or flail segment, and 88% for ruptured chordae. Diagnostic accuracy was higher for TEE than TTE for all end points (p < 0.001), but the difference was of low magnitude (<10%) except for mediocre TTE imaging or flail leaflets (both p < 0.001). The type of mitral lesions identified by TEE (floppy valve, restricted motion, functional lesion) were determinants of valve repairability and postoperative outcome (operative mortality and long-term survival; all p < 0.001) independent of age, gender, ejection fraction and presence of coronary artery disease.
CONCLUSIONS
Transesophageal echocardiography provides a highly accurate anatomic assessment of all types of MR lesions and has incremental diagnostic value if TTE is inconclusive. The functional anatomy of MR defined by TEE is strongly and independently predictive of valve repairability and postoperative outcome. Therefore, the mitral lesions assessed by echocardiography represent essential information for clinical decision making, particularly for the indication of early surgery for MR.
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Abbreviations and Acronyms
| | LV | = left ventricle | | MR | = mitral regurgitation | | TEE | = transesophageal echocardiography | | TTE | = transthoracic echocardiography |
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