Key result
Preoperative 2D-transthoracic echocardiography demonstrated 97.8% agreement (k = 0.93) with surgical findings in localizing prolapsing or flailing scallops in degenerative mitral regurgitation.
Why the study?
Does preoperative 2D-TTE accurately localize prolapsing or flailing scallops/segments compared to surgical findings in patients with severe degenerative mitral regurgitation?
Observational (n=77)
No
Does preoperative 2D-TTE accurately localize prolapsing or flailing scallops/segments compared to surgical findings in patients with severe degenerative mitral regurgitation?
Preoperative 2D-TTE provides high diagnostic accuracy for localizing mitral valve prolapse, particularly for the middle scallops (P2-A2), potentially reducing the need for more invasive imaging.
BACKGROUND: This study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE) segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR). METHODS: Seventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR), including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed. RESULTS: Out of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%), 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity). Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p < 0.0001). Sixty-nine out of 77 2D-TTE reports were completely concordant with SR (89.6% diagnostic accuracy). None of the 8 non-concordant 2D-TTE reports were in complete disagreement with SR. P2 scallop was always involved in posterior leaflet prolapse or flail and was described correctly by 2D-TTE in 68 out of 69 patients (98,7% agreement, k = 0,93; 98.5% sensitivity). The anterior leaflet was involved in 14 patients (18%); A2 segment was involved in all of those cases and was correctly detected by 2D-TTE in 13 (98,7% agreement, k = 0,95; 92,8% sensitivity). Antero-lateral and postero-medial para-commissural prolapse or flail had a lower prevalence (14% and 10% respectively), with 2D-TTE sensitivity respectively of 64% and 50%. CONCLUSIONS: 2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2), which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases.
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Minardi et al. (2010) conducted an observational in Severe degenerative mitral regurgitation (n=77). 2D-transthoracic echocardiography (2D-TTE) vs. Surgical findings was evaluated on Agreement between preoperative 2D-TTE segmental analysis and surgical reports for localization of prolapsing or flailing scallops/segments (k = 0.93, p=<0.0001). Preoperative 2D-transthoracic echocardiography demonstrated 97.8% agreement (k = 0.93) with surgical findings in localizing prolapsing or flailing scallops in degenerative mitral regurgitation.
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