Discussion
The current American Heart Association/American College of Cardiology
Guidelines recommend mitral valve repair as the treatment of choice for
degenerative MR. Both pre- and intra-operative echocardiography are
critical to guiding surgical management in the operating room.
Echocardiography enables evaluation of the of the entire MV apparatus
including the leaflets, annulus and chordae tendineae, the severity and
mechanism of regurgitation, and any additional cardiac pathology that
increases surgical risk. Transthoracic echocardiography, as a low cost
and minimally invasive diagnostic imaging modality, provides the data
needed for clinical decision-making in most patients with chronic
primary MR. When TTE images are inadequate, TEE is recommended. The
severity of MR can be estimated using multiple echocardiographic
parameters such as color doppler, effective regurgitant orifice area,
vena contracta width, and pulmonary blood flow.
Outcomes, including postoperative morbidity/mortality and freedom from
recurrent moderate/severe MR, after mitral valve repair have been
demonstrated to be superior when performed by surgeons with extensive
experience at high volume centers. These findings are consistent with
guidelines recently published by The American College of Cardiology/
American Heart Association as well as the European Society of
Cardiology9,10. The MV complexity score has
demonstrated to have a direct correlation with the difficulty of
surgical repair and the length of cardiopulmonary bypass time, both of
which have implications for postoperative outcomes. The current analysis
suggests the feasibility of using TEE-derived MV complexity scores to
preoperatively stratify degenerative MV repair complexity. This
correlation should permit expedient and cost-effective referral of
appropriate candidates for MV repair to centers of excellence. The
authors accordingly claim that TEE is a practical and useful imaging
modality for stratification of MV complexity with the potential to
improve mitral valve disease outcomes.