Intraoperative assessment of the mitral valve: transesophageal Doppler echocardiography vs. left ventricular filling of the flaccid heart

Several methods can be used for the intraoperative assessment ofresidual mitral regurgitation (MR) following reconstruction of the mitralvalve. The aim of this study was to compare the reliability of two of thesemethods: left ventricular filling of the arrested heart with saline (LVF)and intraoperative transesophageal Doppler echocardiography (TEE).Reliability was assessed by comparing LVF and TEE to postoperative leftventricular angiography (LVA) in 27 patients. LVF, TEE and LVA grading ofMR was 0-4. Correlations, as measured by the Kappa statistic, were asfollows: LVF-LVA: K = 0.33 (95% confidence interval (CI): 0.06-0.59),TEE-LVA: K = 0.48 (95% CI: 0.20-0.77), LVF- TEE: K = 0.43 (95% CI:0.20-0.67). Considering LVF and TEE as predictors of LVA gradings above 2,sensitivities were 0.4 and 0.6, respectively. Specificities were 1.0 foreach method. In conclusion, we found TEE in the beating heart not to besignificantly more reliable in the prediction of residual MR than LVF inthe flaccid heart.