[Intraoperative assessment of the reconstruction of atrioventricular valves using transesophageal echocardiography]

To obtain good results in cardiac valve reconstruction surgery it is necessary to assess intraoperatively the efficiency of mitral or tricuspid valve repair. In 15 patients (three with mitral stenosis, 12 with mitral insufficiency) the mitral valve, in eight patients the tricuspid valve and in two patients both av-valves were reconstructed individually by commissurotomy and/or annulorrhaphy. During cardiac arrest, the valves were tested by filling the left or right ventricle with saline solution. After weaning from the extra-corporeal-circulation (ECC) I-2 cm3 of agitated Gelifundol were injected into the ventricle and the amount of regurgitation of micro-bubbles into the atrium was assessed by intraoperative two-dimensional transesophageal echocardiography. In 20 patients, testing during cardiac arrest and contrast echocardiography showed identical and good results. In two patients, the efficiency of mitral or tricuspid reconstruction could be finally verified by transoesophageal echocardiography. In another patient who was operated because of HOCM and a severe mitral insufficiency, the Bigelow procedure was combined with mitral valve reconstruction. Intraoperative open testing showed a good functional result, but a remaining severe mitral insufficiency was detected by transesophageal contrast echocardiography. An intraoperative decision for valve replacement was made. Our results show that transesophageal contrast echocardiography is a simple and accurate method of assessing the efficiency of valve reconstruction procedures. In some cases it gives more information than testing during cardiac arrest.