Transesophageal echocardiography during mitral valve repair underestimates mitral valve area by pressure half-time calculation

Poh, Kian‐Keong; Hong, Eric; Yang, Hong; Lim, Yu Liang; Yeo, Tiong‐Cheng

doi:10.1016/j.ijcard.2005.04.027

Cited by 17 publications

(5 citation statements)

References 9 publications

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“…Although Hatle et al demonstrated a reliable, inverse correlation between Doppler echocardiographic measurements of PHT and MV orifice area in patients with native MS [38], the same correlation between PHT and MV area could not be demonstrated in patients with MS immediately after mitral valvotomy [14]. Similarly, while Maslow et al demonstrated good agreement and correlation between MV area with PHT and planimetry obtained with two-dimensional echocardiography in patients undergoing MV repair [39], others have shown that intraoperative TEE measurement of PHT following MV repair may be unreliable and can underestimate MV area [15]. In our study, PHT varied considerably and only weakly predicted a requirement for reoperation, suggesting that PHT may be dependent upon hemodynamic variables other than MV orifice area including net left atrial and ventricular compliance [14].…”

Section: Discussionmentioning

confidence: 99%

“…However, alterations in MV orifice geometry following repair, or changes in chamber compliance after cardiopulmonary bypass (CPB) were shown to influence the intra- and postoperative echocardiographic evaluation of MS [14], [15]. The calculation of mitral valve area by pressure half time measurements immediately after mitral valve repair was shown to underestimate the actual mitral valve area [15]. This led to the question which echocardiographic indices of MS severity still provide reliable information in the intraoperative setting, since specific echocardiographic criteria for the diagnosis of acute MS after MV repair have not been well established.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Transmitral Pressure Gradients in the Intraoperative Echocardiographic Diagnosis of Mitral Stenosis after Mitral Valve Repair

et al. 2011

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ObjectiveAcute mitral stenosis (MS) following mitral valve (MV) repair is a rare but severe complication. We hypothesize that intraoperative echocardiography can be utilized to diagnose iatrogenic MS immediately after MV repair.MethodsThe medical records of 552 consecutive patients undergoing MV repair at a single institution were reviewed. Post-cardiopulmonary bypass peak and mean transmitral pressure gradients (TMPG), and pressure half time (PHT) were obtained from intraoperative transesophageal echocardiographic (TEE) examinations in each patient.ResultsNine patients (9/552 = 1.6%) received a reoperation for primary MS, prior to hospital discharge. Interestingly, all of these patients already showed intraoperative post-CPB mean and peak TMPGs that were significantly higher compared to values for those who did not: 10.7±4.8 mmHg vs 2.9±1.6 mmHg; p<0.0001 and 22.9±7.9 mmHg vs 7.6±3.7 mmHg; p<0.0001, respectively. However, PHT varied considerably (87±37 ms; range: 20–439 ms) within the entire population, and only weakly predicted the requirement for reoperation (113±56 vs. 87±37 ms, p = 0.034). Receiver operating characteristic curves showed strong discriminating ability for mean gradients (AUC = 0.993) and peak gradients (area under the curve, AUC = 0.996), but poor performance for PHT (AUC = 0.640). A value of ≥7 mmHg for mean, and ≥17 mmHg for peak TMPG, best separated patients who required reoperation for MS from those who did not.ConclusionsIntraoperative TEE diagnosis of a peak TMPG ≥17 mmHg or mean TMPG ≥7 mmHg immediately following CPB are suggestive of clinically relevant MS after MV repair.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Transmitral Pressure Gradients in the Intraoperative Echocardiographic Diagnosis of Mitral Stenosis after Mitral Valve Repair

et al. 2011

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“…Several studies reported the inaccuracy of PHT technique for MVA measurement, and the reasons such as geometric change of MV structures and net atrioventricular compliance when immediately after CPB ended in MVR [14-16]. And some studies suggested that other parameter such as pressure gradient was more useful for immediate postoperative MV evaluation to detect MS [17,18].…”

Section: Discussionmentioning

confidence: 99%

Determination of mitral valve area with echocardiography, using intra-operative 3-dimensional versus intra- & post-operative pressure half-time technique in mitral valve repair surgery

Kang

Choi

Kang

et al. 2013

J Cardiothorac Surg

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BackgroundWe hypothesized that mitral valve areas (MVAs) with echocardiography, using 3D planimetry technique (measured at one point at maximal opening of mitral valve) versus pressure half-time technique (PHT, measured during entire diastolic phase) in mitral valve repair surgery (MVR) would be different.MethodsPatients who had undergone MVR were retrospectively reviewed, and two different observers measured the MVAs using PHT and 3D planimetry technique. The MVAs derived from recorded medical data, using PHT and 3D planimetry technique were abbreviated to MVA-PHT1 and MVA-3D1, and data from the PHT and 3D planimetry techniques by observer A and observer B were determined as MVA-PHT2 and MVA-3D2, and MVA-PHT3 and MVA-3D3, respectively. The MVA derived by post-operative transthoracic echocardiography using the PHT technique was determined as MVA-TTE.ResultsIntraclass correlation coefficients were 0.90 for the intra-operative PHT technique and 0.78 for the intra-operative 3D planimetry technique. MVA-3D1 (2.91 ± 0.65 cm2), MVA-3D2 (3.00 ± 0.63 cm2) and MVA-3D3 (2.97 ± 0.88 cm2) were significantly larger than MVA-TTE (2.40 ± 0.59 cm2), but intra-operative MVAs-PHT were not. The biases and precisions were larger, and the correlation coefficients were lower in 3D planimetry technique compared with PHT technique.ConclusionsMVA measured by 3D planimetry technique with TEE at the intra-operative post-MVR period was seemed to be larger than that measured by the PHT technique with TTE at the post-operative period. However, it did not mean that the 3D planimetry technique was inaccurate but needs cautions at determination of MVA using different techniques.

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“…The PHT method is also affected by residual MR, aortic regurgitation, and the geometric distortion of the mitral valve postrepair, 30 resulting in an underestimation of MVA by ≥0.5 cm 2 . 31 On the other hand, the transmitral gradient for assessment of functional MVA should be interpreted by considering the cardiac output and heart rate. 30 The high cardiac output and heart rate that may be present immediately after CPB might overestimate the transmitral pressure gradient.…”

Section: Transesophageal Echocardiographic Assessment Of the Mitral V...mentioning

confidence: 99%

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

Reshmi

Gopan

Varma

et al. 2021

Semin Cardiothorac Vasc Anesth

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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.

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Transesophageal echocardiography during mitral valve repair underestimates mitral valve area by pressure half-time calculation

Cited by 17 publications

References 9 publications

Evaluation of Transmitral Pressure Gradients in the Intraoperative Echocardiographic Diagnosis of Mitral Stenosis after Mitral Valve Repair

Evaluation of Transmitral Pressure Gradients in the Intraoperative Echocardiographic Diagnosis of Mitral Stenosis after Mitral Valve Repair

Determination of mitral valve area with echocardiography, using intra-operative 3-dimensional versus intra- & post-operative pressure half-time technique in mitral valve repair surgery

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

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