ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 June;41(3):381-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Usefulness of transesophageal echocardiography during open heart surgery of mitral stenosis

Longo M., Previti A., Morello M., Greco C., Decio A., Pansini S., Morea M., Mangiardi M. L.

From the Department of Internal Medicine Institute of Cardiology and of Cardiovascular Surgery University of Turin, Turin, Italy

Background. The aim of ­this ­study was to ver­i­fy if the use of intra­op­er­a­tive tran­se­soph­a­geal ech­o­car­di­og­ra­phy (TEE), by detect­ing ­mitral insuf­fi­cien­cy or resid­u­al sten­o­sis dur­ing sur­gery, may ­improve medi­um ­term ­results in ­patients ­with ­severe ­mitral sten­o­sis who under­go ­open ­heart val­vu­lo­plas­ty.
Methods. This pros­pec­tive ­study includ­ed twen­ty-two ­patients (20 wom­en and 2 men) ­with a ­mean age of 49±13 ­years ­with ­severe ­mitral sten­o­sis. Mean fol­low-up was 32 ­months (­range 12-55 ­months). All the ­patients under­went trans­tho­rac­ic ech­o­car­di­og­ra­phy (TTE) ­before sur­gery and intra­op­er­a­tive TEE. Before sur­gery the ­mean trans­mi­tral gra­di­ent was 11±6.8 mmHg, the ­mean pres­sure ­half ­time (PHT) ­area was 0.89±0.19 cm2, the ­mean ­echo ­score was 8.9±2.2. Intraoperative TEE ­before the ­repair ­showed a ­mean ­echo ­score of 7.9±1.8.
Results. Two ­patients ­with unsat­is­fac­to­ry ­repair at TEE under­went imme­di­ate ­valve replace­ment. In the remain­ing ­patients, ­mean trans­mi­tral gra­di­ent and PHT ­valve ­area ­before dis­charge was 5.2±3 mmHg and 2.5 cm2. No ­patients had ­more ­than triv­i­al ­mitral regur­gi­ta­tion. During the fol­low-up two ­patients had to be reop­er­at­ed. Patients ­with ­poor imme­di­ate (2 ­patients) or medi­um ­term ­results (2 ­patients), had a ­mean echoc­ar­di­o­graph­ic ­score of 12.24, ­while ­patients ­with a satisfactory medi­um ­term out­come had a ­mean ­score of 7.27 (p<0.001).
Conclusions. Intraoperative TEE may ­guide the sur­geon in the assess­ment of val­vu­lo­plas­ty. However the ­absence of ­mitral regur­gi­ta­tion ­after ­repair and at dis­charge can­not pre­dict the medi­um ­term ­results, ­which are relat­ed to the ­degree of the dis­ease of the ­mitral ­valve.