Comparison of transesophageal echocardiography and transthoracic echocardiography in assessment of severity of mitral stenosis during mitral valve replacement surgery

Background: Assessment of severity by echocardiography includes two-dimensional planimetry of the valve orifice and doppler-derived measurements of the gradient, pressure half-time (PHT), and deceleration time. For that Transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) can be used. Data regarding the comparison of TEE and TTE in assessment of severity of MS during mitral valve replacement surgery is inadequately available. Objective: To assess severity of MS using TTE and TEE compared with actual MVA measured directly with the help of Hegar's dilator. To determine the superiority of TEE over TTE. Methods: The present prospective observational study was carried out in the department of Anesthesiology (CVTS OT), Government Medical College and Superspeciality Hospital, Nagpur from November 2012 to October 2013. Thirty five patients of MS undergoing mitral valve replacement surgery were included in present study. For every patient, after the induction of general anesthesia TTE and TEE was performed and primary outcome measures were noted. During the mitral valve replacement surgery, after opening left Atrium, direct measurements of MVA were done with the aid of Hegar's dilator in every patient. Results:The mean age was 35.26±10.35 years, mean weight was 54.26±9.62 kg; mean height was 155.97±5.61 cm. There were 15 male and 20 female patients in the study. When TEE and TTE were compared with direct measurement, it was found that both the methods were comparable i.e. as per our hypothesis, TEE was not found superior over TTE. Conclusion: Based on these study findings, we conclude that both TEE and TTE are comparable and no method is superior over the other