The use of color flow mapping for intraoperative assessment of valve repair

Repair procedures that preserve a patient's native valve are associated with a lower perioperative and late mortality, a lower incidence of thromboembolic events, and better preservation of left ventricular function than prosthetic replacement. Traditionally employed procedures for intraoperative assessment of the adequacy of repair, such as fluid injection into the arrested ventricle for assessment of valve leakage, measurement of atrial pressure and height of V-waves, and palpation of the atria for the presence of systolic thrills, have not proved to be reliable approaches in the intraoperative evaluation of mitral and tricuspid regurgitation and in the assessment of the adequacy of repair procedures. Intraoperative color Doppler, using either the epicardial or the transesophageal approach, offers rapid and accurate information about the presence and severity of mitral regurgitation at the time of surgery. This technique provides instantaneous evaluation of the adequacy of mitral and tricuspid valvuloplasty and appears capable of predicting postoperative outcome. Intraoperative color Doppler is useful for evaluation of the adequacy of repair before chest closure and may thus help to avoid the need for reoperation. This approach may ultimately allow valve repair procedures to be performed in greater numbers of patients with better control over outcome and with lower reoperation rates.