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Usefulness of Intraoperative Three-dimensional Transesophageal Echocardiography for Mitral Valve Plasty
Keitaro Mahara, Mitsuhiko Ota, Kanako Kishiki, Toshihiro Fukui, Shuichiro Takanashi.
Sakakibara Heart Institute, Tokyo, Japan.

OBJECTIVE:Three-dimensional (3D) transesophageal echocardiography(TEE) has been proven to be superior to two-dimensional(2D) TEE in the assessment of both mitral valve anatomy and mitral regurgitation, promoting its usage in the operating room. We thought to determine 3D TEE improves the identification of mechanisms of residual mitral regurgitation. METHODS: We investigated consecutive 464 patients who scheduled mitral valve plasty for mitral regurgitation in our institution from January 2009 to March 2012. Intraoperative 3DTEE was performed in 461 patients. 46 patients underwent immediate second pump run to repeat mitral repair surgery, and were assigned to 1 of 4 categories according to mechanisms of residual mitral regurgitation, as follows: 1) group1, degenerative ( n = 14 ); 2) group2, cleft or pinhole ( n = 14 ); 3) group3, prolapse ( n = 15); 4) group4, systolic anterior motion ( n = 5 ). RESULTS: Of 46 patients, 14 patients ( 30% ) underwent mitral valve replacement, 11 patients (39%) in group1 ,0 (0%) in group2, 1 (7%) in group3, 2 (40%) in group4 respectively. CONCLUSIONS: Almost all patients in group 2 and 3 could avoid mitral valve replacement. 3DTEE is essential in the operative assessment of mitral regurgitation because accurate determination of origin, lesion localization, and severity is required to determine the surgical techniques and skill level needed to repair the valve.

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