Transesophageal echocardiography in the evaluation of mitral valve disease
- Elyse Foster, MD
Elyse Foster, MD
- Professor of Clinical Medicine
- University of California, San Francisco
- Section Editors
- Warren J Manning, MD
Warren J Manning, MD
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine and Radiology
- Harvard Medical School
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
While transthoracic echocardiography (TTE) is the primary diagnostic modality for evaluation of mitral disease, transesophageal echocardiography (TEE) is an important adjunct in selected patients when more detailed visualization of the mitral valve morphology and of the left atrium (eg, to identify atrial thrombus) is needed.
This topic will discuss the use of TEE in evaluating the mitral valve. TTE of the mitral valve is discussed separately. (See "Echocardiographic evaluation of the mitral valve".)
Mitral regurgitation (MR) is one of the most common derangements of native valves and increases in frequency with age. MR is broadly classified as primary, related to structural abnormalities of the valve itself, or secondary, due to impaired leaflet coaptation associated with underlying left ventricular disease or left atrial disease. Defining the morphology of the valve (figure 1) and the precise mechanism of regurgitation has gained importance in the modern era of surgical and percutaneous mitral valve repair.
The important role transesophageal echocardiography (TEE) plays in the evaluation of mitral regurgitation is due to the proximity of the TEE transducer to the left atrium. In situations that impede transthoracic echocardiography (TTE) (eg, acoustic shadowing from annular calcium or a mitral prosthesis), TEE provides an unobstructed view. TEE provides enhanced views of the mitral valve, which now include three-dimensional (3D) reconstruction to provide detailed information as to the nature of the underlying pathology. The TEE also provides information that is adjunctive to the TTE in determining the severity.
Primary mitral regurgitation — As noted in the American Heart Association/American College of Cardiology (AHA/ACC) guidelines, TEE is indicated in evaluation of patients with chronic primary MR (stages B to D) (table 1) in whom noninvasive imaging provides nondiagnostic information about severity of MR, mechanism of MR, and/or status of left ventricular function . TEE may provide significant additional information in the following conditions that lead to chronic mitral regurgitation.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- MITRAL REGURGITATION
- Primary mitral regurgitation
- - Degenerative mitral valve disease
- - Rheumatic disease
- - Congenital abnormalities
- - Infective endocarditis
- - Degenerative calcific disease
- Secondary mitral regurgitation
- - Ischemic mitral regurgitation
- - Dilated cardiomyopathy
- - Hypertrophic cardiomyopathy
- Severity of mitral regurgitation
- - Color flow Doppler
- - Pulsed-wave Doppler
- - Continuous wave Doppler
- - Evaluation of pulmonary veins
- - Two-dimensional echocardiogram
- - Three-dimensional echocardiogram
- Role of intraoperative transesophageal echocardiography
- Role in transcatheter mitral valve repair
- MITRAL STENOSIS
- Use for percutaneous balloon valvotomy
- Spontaneous echo contrast
- - Left atrial appendage
- Role of intraoperative transesophageal echocardiography