Comparison of the Diagnostic Power of Transthoracic and Transesophageal Echocardiography to Detect Ruptured Chordae Tendineae

Abstract

SummaryPreoperative information concerning the severity and etiology of MR is very important for selecting the most appropriate surgical strategy. Ruptured chordae tendineae (RCT) are one of the most important preoperative findings. We compared the diagnostic power of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) to detect RCT in patients with MR. We studied 61 patients with MR (30 men, 31 women; mean age, 61 ± 12 years) who underwent mitral valve repair or replacement. Both TTE and TEE were performed before the operations, and the sensitivity and specificity of TTE and TEE to detect RCT were determined. In addition, other factors that influenced the detection of RCT by these two methods were investigated. At the time of an operation, RCT was confirmed in 39 of 61 cases. Transesophageal echocardiography had a higher sensitivity than TTE (74% versus 44%; P = 0.006) to detect RCT, although the specificity was not significantly different. In patients with a body mass index (BMI) > 22 (P = 0.023) or MR grade 4 (P = 0.026), TEE had a significantly higher diagnostic sensitivity than TTE, although there was no significant difference in patients with BMI < 22 or MR grade ≤ 3. In the lateral and medial segments of the mitral valve, TEE had a significantly higher diagnostic sensitivity to detect RCT than TTE (P = 0.0012), although there was no significant difference in the middle segments. There was no significant difference between TTE and TEE with respect to the sensitivity to detect RCT in myxomatous mitral valves. Although the sensitivity of TEE was higher than that of TTE to detect RCT, it was affected by BMI, MR grade, the RCT-presenting segments, and the etiology of MR. (Int Heart J 2012; 53: 225-229) Key words: Chorda tendineae, Mitral regurgitation, Myxomatous change, Rupture M itral valve repair, which is one of the surgical treatments for mitral regurgitation (MR), was developed by Carpentier to overcome the potential complications of mitral valve replacement. 1) Recently, mitral valve repair has become one of the most common cardiac surgical procedures, accounting for more than half of all mitral valve procedures.2) Preoperative information concerning the severity and etiology of MR is very important in order to select the most appropriate surgical strategy. Ruptured chordae tendineae (RCT) are one of the most important preoperative findings. Echocardiography is useful for the detection of RCT in MR. Previous reports have shown that the accuracy of transesophageal echocardiography (TEE) to detect RCT in patients with MR is higher than the accuracy of transthoracic echocardiography (TTE).3-9) However, these studies did not evaluate the factors that influenced the diagnostic power of TEE and TTE to detect RCT. Therefore, the purpose of the present study was to investigate the factors that influence the diagnostic power of TTE and TEE to detect RCT. MethodsWe studied 61 patients with MR (30 men, 31 women; age range, 22 to 77 years, mean, 61 ± 12 years) who underwent mitral va...

Diagnostic Accuracy of Transthoracic Echocardiography and Transesophageal Echocardiography for Ruptured Chordae Tendineae: A Meta-Analysis

“…In brief, the reported sensitivity of TTE for detecting RCT has varied considerably. Herein, our study of 6 observational studies, which showed differences in sensitivity of TTE for the diagnosis of RCT that ranged from 0-65% [3,5,6,[9][10][11]. The signi cant heterogeneity based on I2…”

“…Echocardiography is widely used in diagnosing RCT, which has an irreplaceable position [3]. The de nite diagnosis plays a decisive role in the formulation of treatment plans.…”

Sağ Ventriküler Deformasyon Analizi İçin Transözofageal ve Transtorasik Ekokardiyografinin Karşılaştırmalı Değerlendirmesi

“…Furthermore, TEE is also superior to TTE in assessing the appendix functions and morphology, as well as detecting the cardiac mass or anomaly. 3D image support may also increase the success of the procedure by providing the operator with better visibility (8)(9)(10)22). Finally, TEE is the only option when no measurement or assessment can be done by using standard TTE in cases such as obesity or cardiac anatomic variation.…”

“…Furthermore, there are some difficulties because of the eccentric crescent form wrapping the left ventricle, localization behind the sternum and complex contraction mechanism of the RV (3). So, in such cases, transesophageal echocardiography (TEE) may be an excellent alternative to TTE (8)(9)(10).…”

Papillary muscle rupture following acute myocardial infarction: Anatomic, echocardiographic, and surgical insights

“…Moreover, one study employing 2D echocardiographic imaging found that commissural flail went undetected in approximately two-thirds of patients. 14 Failure to identify commissural flail has been attributed to a number of factors including transthoracic imaging [14][15][16][17] and misdiagnosis as leaflet perforation. 14 In this respect, it is worth noting that several authors 13,18 have suggested that 3D imaging ( Figure 9) may provide incremental value in identifying commissural flail.…”