Intraoperative Evaluation of Mitral Stenosis by Transesophageal Echocardiography

Cherry, Anne D.; Maxwell, Cory; Nicoara, Alina

doi:10.1213/ane.0000000000001276

Cited by 8 publications

(1 citation statement)

References 24 publications

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“…Patients underwent TEE examination on the same day and with the same machine used for TTE. The method for planimetric measurement of the MVA was identical for both TEE and TTE examinations as described above …”

Section: Methodsmentioning

confidence: 99%

Level of agreement in three‐dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography

et al. 2019

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Background Echocardiographic measurement of mitral valve area (MVA) is critical prior to percutaneous transmitral commissurotomy (PTMC). This study aimed to compare the agreement between transthoracic (TTE) and transesophageal echocardiography (TEE) in three‐dimensional (3D) planimetric measurement of the MVA among patients with severe mitral stenosis. Methods MVA was measured with planimetry in 105 patients before undergoing PTMC. 3D reconstruction was applied to both TTE and TEE examinations. The MVA values from four different methods of 3D reconstruction were compared to the average values of 3D methods in TEE as the gold standard measurement method for the MVA in this study. The agreement levels between the two examinations were evaluated and analyzed for various reconstruction methods. Results The mean age was 49 ± 12 years for 28 men and 77 women who were enrolled. The image quality was graded as “excellent” in 57% of 3D images obtained by TTE, while it was graded as “excellent” in 81% of 3D images obtained by TEE. The ventricular zooming method in TTE with a bias of −0.006 ± 0.065 cm2 (P < 0.0001) had the highest agreement with the 3D‐MVA in TEE. While 2D‐TTE and 3D‐TEE measurements of the MVA (R = 0.91; P < 0.0001) were significantly correlated, 2D‐TTE overestimated the MVA by 0.19 cm2. Conclusion Although the quality of 3D images was significantly better in TEE than those in TTE, a good agreement existed between the measured 3D‐TTE and 3D‐TEE studies. We also demonstrated that 2D‐TTE overestimated the MVA compare to 3D‐TEE.

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Section: Methodsmentioning

confidence: 99%

Level of agreement in three‐dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography

et al. 2019

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Echocardiographic Imaging of Cardiac Valves

2023

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Diagnostic Value of Three-Dimensional Echocardiography for the Assessment of a Stenotic Caged-Ball Mitral Valve Prosthesis

Essandoh

2019

Journal of Cardiothoracic and Vascular Anesthesia

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associated with a moderate risk of severe upper gastrointestinal bleeding that is increased 10-fold in patients on antithrombotic therapy. 11 Our patient was receiving aspirin and prasugrel to prevent restenosis of a coronary stent, which is a risk factor for gastric injury. Whether TAVI should be performed with the patient under general anesthesia or with regional anesthesia with sedation is unclear. Eskandari et al. reported that neither the outcome of the procedure nor the 30-day and 1-year mortality rates are affected by the mode of anesthesia. 12 However, in a study that used data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, patients who underwent TAVI with moderate sedation had a significantly lower risk of mortality or stroke at 30 days than those in whom TAVI was performed with the patient under general anesthesia despite of an equivalent procedure success rate. 13 No randomized clinical trial has been conducted to determine the most appropriate type of anesthesia for TAVI, and decisions regarding anesthesia are left to institutional heart teams. 13 There is evidence indicating that the incidence of second valve implantation is greater after transthoracic echocardiography (TTE)Àguided TAVI than after TEE-guided TAVI. 14 However, TEE would not be required unless valve deployment was difficult. 13 The clinical criteria for TAVI with sedation without general anesthesia are a straightforward airway, ability to lie flat and cooperate with medical staff, no severe pulmonary hypertension, and no acute procedural complications. 13 If the patient meets these criteria, the heart team could consider performing TAVI with TEE and the patient under regional anesthesia. Manipulation of the probe in a sharp anteflexion position when advancing forward or withdrawing should be avoided when performing TEE in patients receiving antiplatelet therapy to prevent gastric injury. Furthermore, the indication for TAVI should be confirmed using sedation and TTE before surgery. If an iatrogenic gastric injury occurs, we strongly recommend that it be treated in accordance with the European Society of Gastrointestinal Endoscopy position statement.

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Intraoperative Evaluation of Mitral Stenosis by Transesophageal Echocardiography

Cited by 8 publications

References 24 publications

Level of agreement in three‐dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography

Level of agreement in three‐dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography

Echocardiographic Imaging of Cardiac Valves

Diagnostic Value of Three-Dimensional Echocardiography for the Assessment of a Stenotic Caged-Ball Mitral Valve Prosthesis

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