The role of echocardiography in mitral valve dysfunction after repair

The echocardiographer responsible for the intraoperative evaluation should be familiar with the transesophageal echocardiography (TEE) views of mitral valve morphology as well as the the repair procedure(s) in order to assess postoperative results. The most frequent immediate mitral valve repair failures are a result of extensive valve disease, calcification, suture dehiscence, ischemia, technical misadventures, stenosis, or systolic anterior motion. Systolic anterior motion with left ventricular outflow tract obstruction and an associated posteriorly directed jet of mitral regurgitation is the most common cause of immediate failure after mitral valve repair. The incidence of this potentially devastating complication has decreased dramatically since the introduction of preoperative measures (sliding annuloplasty and anterior leaflet valvuloplasty) in those patients at risk. Intraoperative TEE is extremely valuable in evaluating the competency of the mitral valve following repair. In fact the results of this modality have a predictive valve in determining long-term outcomes in these patients.