712-1 Intraoperative Transesophageal Echocardiography Under-Estimates the Severity of Functional Mitral Regurgitation

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.82A-82A
• Main Authors: Bach, David S., Donovan, Carolyn L., Brunsting, Louis A., Deeb, G. Michael, Bolling, Steven F.
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)91792-V

Although intraoperative transesophageal echocardiography (TEE) has been used to guide the need for valve reconstruction in patients with mitral regurgitation (MR), the effects of hemodynamic alterations accompanying general anesthesia on MR jet size are unknown. This study was undertaken to compare MR jet size before and after the induction of general anesthesia. 46 of 133 patients undergoing mitral valve surgery between 11/92 and 4/94 had TEE performed both preoperatively under IV conscious sedation (preOp) and intraoperatively following induction of general anesthesia (IntraOp), 21 of 46 patients (46%) had degenerative mitral disease with leaflet flail (Flail) and 25 (54%) had functional MR as a result of annular dilation (Functional). The width of the MR jet at its vena contracta (Width) and the maximal jet area (Area) were determined for each patient on both PreOp and IntraOp TEE. Doppler Nyquist limits for paired studies were similar. Systolic blood pressure (SBP) and pressure rate product (PRP) at the time of MR jet measurements were available for 33 patients (72%).FlailFunctionalPreOpIntraOpPreOpIntraOpSBP(mmHg)116±17123±17108±17120±19†PRP x 100103±9797±22†95±2297±23†Width (mm)1.1±0.31.0±0.3†1.0±030.7±0.3*Area (cm2)10.1±5.29.8±4.5†9.0±4.35.4±3.9*†P=NS VS. PreOp*p<0.001 vs. PreOp We conclude that 1) MR related to leaflet flail is adequately quantified on IntraOp TEE, whereas 2) the severity of functional MR may be significantly underestimated in patients under general anesthesia. Alteration of systemic vascular resistance independent of blood pressure may be responsible for this observation. Patients with functional MR in whom mitral surgery is considered should undergo imaging for MR quantification prior to the induction of general anesthesia.