Transesophageal Echocardiographic Assessment of the Repaired Mitral Valve: A Proposed Decision Pathway

Abstract

The indications for mitral valve repair extend across the entire spectrum of degenerative mitral valve disease, ranging from fibroelastic degeneration to Barlow’s disease. Collaboration between the surgeon and anesthesiologist is essential for ensuring optimal results. Echocardiographic assessment of the repair can be challenging but is essential to the success of the procedure, as even mild residual mitral regurgitation can portend poor patient outcomes. In addition to determining the severity of residual regurgitation, the anesthesiologist must elucidate the mechanism of disease in order to inform appropriate re-intervention measures. Finally, there are unique complications of mitral valve surgery for the anesthesiologist to understand and assess by echocardiography. This review describes a systematic pathway for a comprehensive intraoperative assessment of the mitral valve following surgical repair.

Intraoperative transesophageal echocardiography following mitral valve repair: a systematic review

“…Follow-up echocardiographic data showed a significant correlation between postoperative aorto–mitral angle and reduced left atrial diameter at 50.3 months after surgery. Compared with C-shape bands, full rings may impose less narrowing on aorto–mitral angle, which correlates well with mid-term left atrial reverse remodeling Maffessanti et al (2011) 21 Quantified the effects induced by prolapse on MV anatomy in the presence of FED or Barlow's disease, assess the effect of surgery on the MV apparatus, and investigate the potential role of 3D-TEE in surgical planning. Prospective observational study.…”

“…These studies also demonstrate excellent correlation between TEE and surgical findings in both simple 14 and complex pathologies, 15 providing a structured comprehensive approach on how to perform a post-CPB exam that addresses separation from CPB, MV assessment (competency, patency and restoration of leaflet coaptation), Left Ventricular (LV) global and regional function, Left Ventricular Outflow Tract (LVOT) assessment for MV systolic anterior motion, and presence of new aortic insufficiency. 6 , 16 , 17 , 18 , 19 , 20 , 21 …”

An Overview about Mitral Valve Replacement Surgery Options: Review Article

“…After an inconclusive transthoracic echocardiogram (TTE), a transesophageal echocardiogram (TEE) is required for surgical guidance, however its contraindications limit the applicability of a minimally invasive approach. Radial coronary angiography is preferable to femoral angiography before surgery in order to preserve femoral access (30) .…”

“…Vascular checkup: Peripheral cannulation for minimally invasive mitral valve surgery (MIMVS) is performed through the femoral artery. For the vascular workup, surgical teams may opt for either an aortic or coronary CT scan (30) .…”

Cardiac Anesthesiology – Paving the Way across Multiple Subspecialties

“…However, the changes in loading conditions due to general anesthesia and CPB add additional challenges for the intraoperative echocardiographer and their surgical colleagues to grade and appropriately manage residual MR after attempts at surgical repair. Thus, Reshmi et al 9 have reframed the discussion of MR into the context of the intraoperative conditions found immediately after attempts to repair the valve and weaning from CPB. How much residual MR is acceptable?…”