Valvular Heart Disease
Valvular abnormalities detected with TEE have important implications.
In one study, intraoperative TEE detected mitral regurgitation so severe in 5 of
182 patients scheduled for coronary artery surgery that unscheduled mitral valve
repair was performed.[97]
Conversely, in 22 of
51 patients scheduled for combined coronary artery and mitral valve surgery, TEE
revealed so little mitral valve dysfunction that the mitral repair was omitted.
In another study, 6 of 383 patients undergoing aortic valve replacement had unscheduled
mitral valve surgery based on the intraoperative diagnosis of severe mitral regurgitation
by TEE.[98]
In this same patient group, 25 scheduled
mitral valve surgeries were omitted because of findings on intraoperative TEE. In
a third study that prospectively evaluated 5016 patients, pre-bypass information
from TEE led to modification of the surgical procedure in 12% of the patients undergoing
valve procedures and 27% of the patients undergoing coronary surgery.[99]
TEE is essential when mitral valve repair is anticipated. It provides a highly
accurate anatomic assessment of the mitral valve and is strongly and independently
predictive of valve reparability and postoperative outcome.[35]
[100]
[101]
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