Circulation, Vol 84, 594-604, Copyright © 1991 by American Heart Association
KH Sheikh, JR Bengtson, JS Rankin, NP de Bruijn and J Kisslo
BACKGROUND. Intraoperative transesophageal Doppler color flow imaging
(TDCF) affords the opportunity to assess mitral valve competency
immediately before and after cardiopulmonary bypass (CPB). The purpose of
this study was to assess the utility of TDCF to assist in the selection and
operative treatment of ischemic mitral regurgitation (MR). METHODS AND
RESULTS. Two hundred forty-six patients undergoing surgery for ischemic
heart disease were prospectively studied. All had preoperative cardiac
catheterization. Catheterization and pre-CPB TDCF were discordant in their
estimation of MR in 112 patients (46%). Compared with patients in whom both
techniques agreed in estimation of MR, patients with discordance in MR were
more likely to have had unstable clinical syndromes at the time of
catheterization (79% versus 40%, p less than 0.05) or to have received
thrombolytics (16% versus 8%, p less than 0.05). Pre-CPB TDCF resulted in a
change in the operative plan with respect to the mitral valve in 27
patients (11%). Because less MR was found by TDCF than catheterization, 22
patients had only coronary bypass grafting when combined coronary bypass
and mitral valve surgery had been planned. Because more MR was found by
TDCF than catheterization, five patients had combined coronary bypass and
mitral valve surgery when coronary bypass alone had been planned.
Unsatisfactory results noted by TDCF following mitral valve surgery in five
patients resulted in immediate corrective surgery. Cox regression analysis
identified residual MR at the completion of surgery to be an important
predictor of survival (chi 2 = 21.4) after surgery--more important than
patient age (chi 2 = 8.3) or left ventricular ejection fraction (chi 2 =
5.3). CONCLUSIONS. These results indicate that TDCF is useful in guiding
patient selection and operative treatment of ischemic MR and that in such
patients, intraoperative TDCF should be performed routinely.
ARTICLES
Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
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