Key result
Intraoperative transesophageal echocardiography (sensitivity 0.6, Kappa 0.48) was not significantly more reliable than left ventricular filling (sensitivity 0.4, Kappa 0.33) for predicting residual MR.
Why the study?
Does intraoperative transesophageal Doppler echocardiography improve the reliability of predicting residual mitral regurgitation compared to left ventricular filling of the arrested heart in patients undergoing mitral valve reconstruction?
Observational (n=27)
Does intraoperative transesophageal Doppler echocardiography improve the reliability of predicting residual mitral regurgitation compared to left ventricular filling of the arrested heart in patients undergoing mitral valve reconstruction?
Effect estimate: K = 0.48 (95% CI 0.20-0.77)
Intraoperative TEE in the beating heart was not found to be significantly more reliable than saline filling of the flaccid heart for predicting residual mitral regurgitation after valve reconstruction.
No advantage of intraoperative TEE over LV filling for residual MR prediction; leaves open optimal intraoperative assessment method.
Several methods can be used for the intraoperative assessment of residual mitral regurgitation (MR) following reconstruction of the mitral valve. The aim of this study was to compare the reliability of two of these methods: left ventricular filling of the arrested heart with saline (LVF) and intraoperative transesophageal Doppler echocardiography (TEE). Reliability was assessed by comparing LVF and TEE to postoperative left ventricular angiography (LVA) in 27 patients. LVF, TEE and LVA grading of MR was 0-4. Correlations, as measured by the Kappa statistic, were as follows: LVF-LVA: K = 0.33 (95% confidence interval (CI): 0.06-0.59), TEE-LVA: K = 0.48 (95% CI: 0.20-0.77), LVF-TEE: K = 0.43 (95% CI: 0.20-0.67). Considering LVF and TEE as predictors of LVA gradings above 2, sensitivities were 0.4 and 0.6, respectively. Specificities were 1.0 for each method. In conclusion, we found TEE in the beating heart not to be significantly more reliable in the prediction of residual MR than LVF in the flaccid heart.
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Moulijn et al. (1992) conducted an observational in Residual mitral regurgitation following reconstruction of the mitral valve (n=27). Intraoperative transesophageal Doppler echocardiography (TEE) vs. Left ventricular filling of the arrested heart with saline (LVF) was evaluated on Reliability of MR grading compared to postoperative left ventricular angiography (LVA) (K = 0.48, 95% CI 0.20-0.77). Intraoperative transesophageal echocardiography (sensitivity 0.6, Kappa 0.48) was not significantly more reliable than left ventricular filling (sensitivity 0.4, Kappa 0.33) for predicting residual MR.
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