Circulation, Vol 81, 556-566, Copyright © 1990 by American Heart Association
WJ Stewart, PJ Currie, EE Salcedo, BW Lytle, CC Gill, WA Schiavone, DA Agler and DM Cosgrove
Mitral valve repair provides substantial advantages over mitral valve
replacement in patients with severe mitral regurgitation. However, because
of the possibility of persistent regurgitation, an intraoperative technique
is needed to provide an immediate and accurate assessment of the adequacy
of the repair before closure of the chest. One hundred patients with pure
mitral regurgitation were studied with intraoperative epicardial Doppler
color flow mapping immediately before and after valve repair.
Intraoperative assessment of the severity of mitral regurgitation showed
good agreement with preoperative left ventriculography and with standard
precordial Doppler echocardiography before and after surgery. Postrepair
intraoperative Doppler studies showed satisfactory surgical results in 92
patients. Postrepair intraoperative Doppler studies in the remaining eight
patients demonstrated unsatisfactory results: persistent significant
regurgitation in four, systolic anterior motion of the mitral valve with
dynamic left ventricular outflow tract obstruction in three, and a
persistent flail leaflet in one. In six of the eight patients, further
surgery was performed during the same thoracotomy. In two patients, the
intraoperative postrepair Doppler findings of persistent regurgitation were
confirmed on precordial Doppler studies within 5 days, and mitral
reoperation was required. Intraoperative epicardial Doppler color flow
mapping provided a "safety net" that ensured a successful outcome in all
100 patients by providing the surgeon with a direct means to assess the
success of the operation and the need for further surgery.
ARTICLES
Intraoperative Doppler color flow mapping for decision-making in valve repair for mitral regurgitation. Technique and results in 100 patients
Department of Cardiology and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44106.
This article has been cited by other articles:
 |
|
 |
|
  2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]
|
|
|
|
 |
|
 W. J. Stewart Imaging the future of transcatheter aortic valve replacement. J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 25 - 28. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2008; 3(2008): 785 - 802. [Full Text]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Fox, K. Glas, M. Swaminathan, and S. Shernan The Impact of Intraoperative Echocardiography on Clinical Outcomes Following Adult Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 25 - 40. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Mesana, M. Ibrahim, and M. Hynes A Technique for Annular Plication to Facilitate Sliding Plasty After Extensive Mitral Valve Posterior Leaflet Resection Ann. Thorac. Surg., February 1, 2005; 79(2): 720 - 722. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. A. Zoghbi, M. Enriquez-Sarano, E. Foster, P. A. Grayburn, C. D. Kraft, R. A. Levine, P. Nihoyannopoulos, C. M. Otto, M. A. Quinones, H. Rakowski, et al. American Society of Echocardiography: recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography : A report from the American Society of Echocardiography's Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee, Council on Clinical Cardiology, The American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by: Eur J Echocardiogr, December 1, 2003; 4(4): 237 - 261. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan Intraoperative Echocardiography Card. Surg. Adult, January 1, 2003; 2(2003): 283 - 314. [Full Text]
|
|
|
|
|
|
R. C. Gorman, J. H. Gorman III, and L. H. Edmunds Jr. Ischemic Mitral Regurgitation Card. Surg. Adult, January 1, 2003; 2(2003): 751 - 769. [Full Text]
|
|
|
|
|
|
A. M. Gillinov and D. M. Cosgrove III Mitral Valve Repair Card. Surg. Adult, January 1, 2003; 2(2003): 933 - 950. [Full Text]
|
|
|
|
|
|
C. T. Bajzer, W. J. Stewart, D. M. Cosgrove, S. J. Azzam, K. L. Arheart, and A. L. Klein Tricuspid valve surgery and intraoperative echocardiography: Factors affecting survival, clinical outcome, and echocardiographic success J. Am. Coll. Cardiol., October 1, 1998; 32(4): 1023 - 1031. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. Koch The Use of Echocardiography in the Intensive Care Unit Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1998; 2(1): 52 - 65. [Abstract] [PDF]
|
|
|
|
|
|
R. M. Savage, B. W. Lytle, S. Aronson, J. L. Navia, M. Licina, W. J. Stewart, N. J. Starr, and F. D. Loop Intraoperative Echocardiography Is Indicated in High-Risk Coronary Artery Bypass Grafting Ann. Thorac. Surg., August 1, 1997; 64(2): 368 - 373. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. J. Brener, F. D. Loop, B. W. Lytle, S. G. Ellis, D. M. Cosgrove, and E. J. Topol A PROFILE OF CANDIDATES FOR REPEAT MYOCARDIAL REVASCULARIZATION: IMPLICATIONS FOR SELECTION OF TREATMENT J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 153 - 161. [Abstract] [Full Text]
|
|
|
|
|
|
D. Mele, P. Vandervoort, I. Palacios, J. M. Rivera, R. E. Dinsmore, E. Schwammenthal, J. E. Marshall, A. E. Weyman, and R. A. Levine Proximal Jet Size by Doppler Color Flow Mapping Predicts Severityof Mitral Regurgitation : Clinical Studies Circulation, February 1, 1995; 91(3): 746 - 754. [Abstract] [Full Text]
|
|
|
|
 |
|
 Y. Suenaga, A. Io, K. Tajima, M.-H. Song, and T. Shimomura Intraoperative Evaluation of Valvular Function Using Transesophageal and Epicardial Echocardiography Vascular and Endovascular Surgery, January 1, 1995; 29(1): 1 - 14. [Abstract] [PDF]
|
|
|
|
|
|
T. Shimono, H. Yuasa, T. Mizumoto, K. Hatanaka, H. Kusagawa, and I. Yada New surgical method of chordal replacement for mitral valve incompetence with echocardiographic guidanceAn experimental study J. Thorac. Cardiovasc. Surg., October 1, 1994; 108(4): 719 - 726. [Abstract] [Full Text]
|
|