Prediction of Surgical Strategy in Mitral Valve Regurgitation Based on Echocardiography

Behalf of The ESMIR Research Group of the Interuniversity Cardiology Institute of The Netherlands11
See Appendix for members of the ESMIR Research Group.,; Hellemans, MD, Irene M.; Pieper, MD, Els G.; Ravelli, MS, Anita C.J.; Hamer, MD, Johannes P.M.; Jaarsma, MD, Wybren; Cheriex, MD, Emile; Peels, Cathinka H.; Bakker, MD, Patricia F.A.; Tijssen, PhD, Jan G.P.; Visser, MD, Cees A.

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Volume 79, Issue 3 , Pages 334-338, 1 February 1997

Prediction of Surgical Strategy in Mitral Valve Regurgitation Based on Echocardiography

Behalf of The ESMIR Research Group of the Interuniversity Cardiology Institute of The Netherlands¹
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Irene M. Hellemans, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
- Irene M. Hellemans, MD, Department of Cardiology, Free University Hospital, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Els G. Pieper, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Anita C.J. Ravelli, MS
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Johannes P.M. Hamer, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Wybren Jaarsma, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Emile Cheriex, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Cathinka H. Peels
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Patricia F.A. Bakker, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Jan G.P. Tijssen, PhD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
Cees A. Visser, MD
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands

Received 12 March 1996; accepted 8 August 1996.

Abstract

The purpose of this prospective multicenter study of 350 consecutive patients who were accepted for mitral valve surgery because of severe regurgitation, was to assess the value of preoperative transthoracic and transesophageal echocardiography in predicting the surgical strategy in severe mitral regurgitation: repair or replacement. The cardiologist predicted the surgical strategy on the basis of the echocardiographic examination, according to predefined guidelines for repair and replacement. The predicted strategy and motivation thereof were compared with the surgical findings and procedure that was performed. Agreement on the basis of transthoracic echocardiography was reached in 86% of the repair patients and on the basis of transesophageal echocardiography in 89%. Agreement on the basis of transthoracic echocardiography was reached in 74% of the replacement patients and on the basis of transesophageal echocardiography in 75%. This study underlines the potential role of echocardiography in predicting the surgical procedure to be applied, provided that both surgeon and cardiologist use the same nomenclature and that the guidelines for replacement/repair are adhered to. Both transthoracic and transesophageal echocardiography appear to be equally accurate in predicting the optimal surgical procedure in this respect.

To assess the value of preoperative transthoracic and transesophageal echocardiography in predicting the surgical strategy (repair or replacement) in severe mitral regurgitation, a prospective multicenter study of 350 patients undergoing surgery for mitral regurgitation was conducted. Both monoplane transesophageal and transthoracic echocardiography were equally accurate in predicting the optimal surgical procedure in almost all patients.