Usefulness of transesophageal echocardiography during open heart surgery of mitral stenosis

The aim of this study was to verify if the use of intraoperative transesophageal echocardiography (TEE), by detecting mitral insufficiency or residual stenosis during surgery, may improve medium term results in patients with severe mitral stenosis who undergo open heart valvuloplasty.

This prospective study included twenty-two patients (20 women and 2 men) with a mean age of 49+/-13 years with severe mitral stenosis. Mean follow-up was 32 months (range 12-55 months). All the patients underwent transthoracic echocardiography (TrE) before surgery and intraoperative TEE. Before surgery the mean transmitral gradient was 11+/-6.8 mmHg, the mean pressure half time (PHT) area was 0.89+/-0.19 cm2, the mean echo score was 8.9+/-2.2. Intraoperative TEE before the repair showed a mean echo score of 7.9+/-1.8.

Two patients with unsatisfactory repair at TEE underwent immediate valve replacement. In the remaining patients, mean transmitral gradient and PHT valve area before discharge was 5.2+/-3 mmHg and 2.5 cm2. No patients had more than trivial mitral regurgitation. During the follow-up two patients had to be reoperated. Patients with poor immediate (2 patients) or medium term results (2 patients), had a mean echocardiographic score of 12.24, while patients with a satisfactory medium term outcome had a mean score of 7.27 (p<0.001).

Intraoperative TEE may guide the surgeon in the assessment of valvuloplasty. However the absence of mitral regurgitation after repair and at discharge cannot predict the medium term results, which are related to the degree of the disease of the mitral valve.