AUTHOR=Zhou Li , Gu Ji-wei , Wang Yun , Ye Jing-jing , Wang Fang , Wang Ting-ting , Jiang Bo , Na Li-sha 

TITLE=The Application of Transesophageal Echocardiography in Mitral Valve Repair With Tendon Reconstruction

JOURNAL=Frontiers in Surgery

VOLUME=Volume 7 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2020.599746

DOI=10.3389/fsurg.2020.599746

ISSN=2296-875X

ABSTRACT=Objective To investigate whether tendon reconstruction during mitral valvuloplasty can be effectively guided by transesophageal echocardiography (TEE), using the mid-esophageal bicaval view and the aortic–mitral valve transition short-axis view. Methods A total of 40 patients that underwent mitral valvuloplasty with artificial tendineae were recruited. Before the operation, conventional transthoracic echocardiography was used to determine whether mitral valvuloplasty would be possible. Following intraoperative anesthesia, two-dimensional and three-dimensional TEE reconstructions were used to assess the state of the valve and tendon and to make a repair plan. Results TEE accurately diagnosed single functional tendon rupture and predicted single artificial tendon implantation in 88% of cases (23/26). TEE accurately diagnosed single functional tendon rupture and predicted the implantation of two artificial tendons in 100% of cases (4/4). TEE accurately diagnosed two or more functional tendon ruptures and predicted the implantation of two artificial tendons in 100% of cases (5/5). The length of the tendon cord predicted by TEE (2.45 ± 0.15 mm) was not significantly different (P > 0.05) from the length of the cord that was actually implanted (2.31 ± 0.11 mm). TEE also accurately predicted the size of the annuloplasty ring in 86% of cases (30/35), with differences of 2 mm or less compared to the size of the ring that was actually implanted. Conclusion Both the mid-esophageal bicaval view and the short-axis view of the aortic–mitral valve transition can reduce the difficulty of tendon reconstruction by helping to determine what length of tendon and what size of artificial annulus are required.