Abstract 3352: Functional Assessment of the Mechanisms of Aortic Regurgitation by Transesophageal Echocardiography: Diagnostic Accuracy and Prediction of Surgical Repairability
Background: For patients with aortic regurgitation (AR), aortic valve repair is an attractive, albeit technically demanding, surgical alternative to aortic valve replacement. In this setting, accurate pre-operative delineation of aortic valve pathology and potential repairability is of paramount importance.
Aim: To assess the diagnostic value of pre-operative transesophageal echocardiography (TEE) in defining the mechanisms of AR, as identified by surgical inspection, and in predicting repairability, by using the final surgical approach as reference.
Method: 100 consecutive patients (71 males, mean age: 57±17 years) undergoing surgical correction of a significant AR were included. Mechanisms of AR were categorized by TEE and surgical inspection as follows: type 1 A-C: aortic dilatation, type 1 D: cusp perforation, type 2: cusp prolapse, type 3: restrictive cusp motion. Aortic dissection and endocarditis were also considered as specific diagnoses.
Results: At surgery, mechanisms of AR were type 1 A-C in 25 pts, type 1D in 8 pts, type 2 in 31 pts, type 3 in 22 pts, aortic dissection in 3 pts and aortic valve endocarditis in 11 pts. Agreement between TEE and surgical inspection was 92% (Kappa: 0.90). Misdiagnoses concerned cusp prolapses, which were confused with free edge fenestration on TEE. Aortic repair was performed in 75 pts and valve replacement in 25 pts. TEE correctly predicted the final surgical approach in 66/75 pts undergoing successful repair (sensitivity: 88%) and in 24/25 pts undergoing replacement (specificity: 96%).
Conclusions: In pts with AR, TEE allows for the accurate delineation of both the underlying mechanisms and possible repairability.