712-2 Comparison of Transesophageal Echocardiographic and Surgical Assessment of Mitral Regurgitant Lesions: Accuracy and Incremental Value

Transesophageal echocardiographic (TEE) provides superb images of the mitral valve. In patients with mitral regurgitation (MR) the type of lesion conditions the ability to perform a valve repair, suggesting liberal indications of TEE preoperatively. However, the accuracy of TEE and its incremental value over transthoracic echocardiography(TTE) are not available to determine the proper utilization of resources. Among 347 patients operated on between 1988 and 1991 for pure, isolated MR, 248 had a preoperative TEE (age=64±14 years, 152 males) and 216 of them had a preoperative TTE. The accuracy (Ac) of TTE and TEE, the percentage of patients with incremental accuracy of TEE (% Inc) and the percentage of TTE errors corrected by TEE (% Corr) were:Acc TEEAcc TTEP% Inc% CorrEtiology99%95%0.0083.7%80%Mechanism99%94%0.0024.6%77%Vegetations99%95%0.0083.7%73%Prolapse93%80%0.00113.9%70%Flail segment96%80%0.00116.2%81%Rupture chord87%57%0.00132.4%75%The % Inc was significantly higher when the anatomy was felt to be incompletely described by the observer (vegetations 15% vs 1%, P=0.0001, prolapse 36% vs 9%, P=0.0001).In conclusion, 1)the high resolution imaging of TEE allows a high accuracy of anatomic assessment but, 2)the incremental value over TTE is moderate and most significant for ruptured chordae or when TTE is incomplete and thus, 3)TEE should be performed preoperatively in selected cases in which the probability for incremental value is high