Transesophageal Echocardiography for Mitral Valve Repair Surgery

Mitral valve repair has become the procedure of choice for most diseases of the mitral valve as it preserves both the valvular and subvalvular apparatus. In contrast to mitral valve replacement surgery, patients undergoing mitral valve repair have lower in-hospital mortality and length of stay and improved long-term survival.

Several factors have contributed to the evolution of new techniques for mitral valvuloplasty, including changing patient demographics and increased use of intraoperative transesophageal echocardiography (IOE).1-3 Demographically, there are fewer patients with rheumatic disease and more patients with mitral valve disorders that are amenable to repair, such as primary mitral valve degenerative disease or mitral regurgitation (MR} resulting from coronary artery disease. Concurrently, improved diagnostics by physicians skilled in using IOE have increased the potential candidates for mitral valve repair-for example, patients whose mitral valve disease can be diagnosed at the time of coronary artery bypass surgery. Information derived from IOE data can help determine the cause and severity of the mitral valve disease, assess the feasibility of performing a repair, and determine the success of the repair or if further intervention is needed. Medical causes of postoperative MR (systolic anterior motion of the anterior mitral leaflet or the chordae) must be ruled out in advance.4-6