Transesophageal versus transthoracic echocardiography for diagnosing mitral valve perforation

Perforation of a mitral valve leaflet is uncommon. Most perforations are the result of bacterial endocarditis. Although mitral regurgitation is readily diagnosed by Doppler echocardiography, identification of leaflet perforation by conventional transthoracic echocardiography (TTE) may be difficult. Limitations in resolution, reverberatory echoes and signal dropout may contribute to this problem. 1 Improved visualization of mitral valve pathology by transesophageal echocardiography (TEE) has been well documented in patients with bacterial endocarditis. 2–4 In this study of 10 patients with mitral valve perforation we compared the diagnostic sensitivity of TTE with that of TEE for the demonstration of mitral valve perforation, valvular vegetation and mitral valve aneurysm. We also report an association of aortic regurgitation with mitral valve perforation.