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Transesophageal echocardiography in the evaluation of mitral valve disease

Elyse Foster, MD
Section Editors
Warren J Manning, MD
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


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 [1]. TEE may provide significant additional information in the following conditions that lead to chronic mitral regurgitation.

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Literature review current through: Nov 2017. | This topic last updated: Jun 16, 2017.
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