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Transthoracic and transesophageal echocardiography pre and post percutaneous mitral catheter balloon valvulotomy
S J Hutchinson1, R G Smalling, A Ma
1Division of Cardiology, Los Angeles County/University of Southern California Medical Center.
Insights
Transesophageal echocardiography (TEE) offers complementary findings to transthoracic echocardiography (TTE) for mitral stenosis patients undergoing catheter balloon valvulotomy (CBV). However, routine TEE use shows limited additional clinical value beyond thrombus detection.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Catheter balloon valvulotomy (CBV) effectively treats rheumatic mitral stenosis.
- Echocardiography, including transthoracic (TTE) and transesophageal (TEE), is used for mitral valve assessment.
- The routine utility of TEE before and after CBV remains unclear.
Purpose of the Study:
- To prospectively evaluate the role of TEE compared to TTE in assessing mitral valve morphology and complications before and after CBV.
Main Methods:
- Prospective study of 14 mitral stenosis patients undergoing CBV.
- Mitral valve morphologic scoring using both TTE and TEE.
- Assessment of mitral stenosis complications and CBV-related complications.
Main Results:
- Mitral valve scoring was similar between TTE and TEE, though TEE tended to underestimate scores pre-CBV.
- TEE uniquely detected a single thrombus; both modalities detected torn chordae and atrial septal defects (ASDs) variably.
- Increased mitral insufficiency post-CBV was similarly detected, with TEE suggesting higher grades.
Conclusions:
- TEE provides complementary findings to TTE in the pre- and post-CBV setting.
- Routine TEE use offers limited additional clinical benefit over TTE, except for thrombus detection.
- Larger studies are needed to definitively establish the contribution of routine TEE.
Abstract:
Catheter balloon valvulotomy (CBV) is useful in the relief of rheumatic mitral stenosis. Morphologic scoring of the mitral valve by transthoracic echocardiography is predictive of success with CBV. Horizontal plane transesophageal echocardiography can obtain high quality images of the mitral valve and left atrium, but its value with routine use in the pre and post CBV setting is unknown. We prospectively examined 14 patients with mitral stenosis, pre and post CBV, noting scores, complications of mitral stenosis, and complications of CBV. Mitral valve scoring was similar by TTE and TEE pre and post CBV, but TEE did tend to underestimate scores pre CBV. There was a single thrombus, it was detected only by TEE. Post CBV, both TTE and TEE detected one of two torn chordae. Of three patients with ASD's by colour flow mapping, TTE and TEE each detected two. Increases in mitral insufficiency post CBV were seen equally frequently by TTE and TEE. The increases appeared to be of a higher grade (NS) by TEE. TTE and TEE yielded complementary findings, pre and post CBV. Other than for the detection of thrombi through, the net clinical contribution of routine use of TEE appears small, and large series would be needed to establish its contribution.