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Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation.

Publication ,  Journal Article
Sheikh, KH; Bengtson, JR; Rankin, JS; de Bruijn, NP; Kisslo, J
Published in: Circulation
August 1991

BACKGROUND: Intraoperative transesophageal Doppler color flow imaging (TDCF) affords the opportunity to assess mitral valve competency immediately before and after cardiopulmonary bypass (CPB). The purpose of this study was to assess the utility of TDCF to assist in the selection and operative treatment of ischemic mitral regurgitation (MR). METHODS AND RESULTS: Two hundred forty-six patients undergoing surgery for ischemic heart disease were prospectively studied. All had preoperative cardiac catheterization. Catheterization and pre-CPB TDCF were discordant in their estimation of MR in 112 patients (46%). Compared with patients in whom both techniques agreed in estimation of MR, patients with discordance in MR were more likely to have had unstable clinical syndromes at the time of catheterization (79% versus 40%, p less than 0.05) or to have received thrombolytics (16% versus 8%, p less than 0.05). Pre-CPB TDCF resulted in a change in the operative plan with respect to the mitral valve in 27 patients (11%). Because less MR was found by TDCF than catheterization, 22 patients had only coronary bypass grafting when combined coronary bypass and mitral valve surgery had been planned. Because more MR was found by TDCF than catheterization, five patients had combined coronary bypass and mitral valve surgery when coronary bypass alone had been planned. Unsatisfactory results noted by TDCF following mitral valve surgery in five patients resulted in immediate corrective surgery. Cox regression analysis identified residual MR at the completion of surgery to be an important predictor of survival (chi 2 = 21.4) after surgery--more important than patient age (chi 2 = 8.3) or left ventricular ejection fraction (chi 2 = 5.3). CONCLUSIONS: These results indicate that TDCF is useful in guiding patient selection and operative treatment of ischemic MR and that in such patients, intraoperative TDCF should be performed routinely.

Duke Scholars

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

August 1991

Volume

84

Issue

2

Start / End Page

594 / 604

Location

United States

Related Subject Headings

  • Prospective Studies
  • Personnel Selection
  • Mitral Valve Insufficiency
  • Middle Aged
  • Male
  • Intraoperative Period
  • Humans
  • Female
  • Esophagus
  • Echocardiography
 

Citation

APA
Chicago
ICMJE
MLA
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Sheikh, K. H., Bengtson, J. R., Rankin, J. S., de Bruijn, N. P., & Kisslo, J. (1991). Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation, 84(2), 594–604. https://doi.org/10.1161/01.cir.84.2.594
Sheikh, K. H., J. R. Bengtson, J. S. Rankin, N. P. de Bruijn, and J. Kisslo. “Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation.Circulation 84, no. 2 (August 1991): 594–604. https://doi.org/10.1161/01.cir.84.2.594.
Sheikh KH, Bengtson JR, Rankin JS, de Bruijn NP, Kisslo J. Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation. 1991 Aug;84(2):594–604.
Sheikh, K. H., et al. “Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation.Circulation, vol. 84, no. 2, Aug. 1991, pp. 594–604. Pubmed, doi:10.1161/01.cir.84.2.594.
Sheikh KH, Bengtson JR, Rankin JS, de Bruijn NP, Kisslo J. Intraoperative transesophageal Doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation. 1991 Aug;84(2):594–604.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

August 1991

Volume

84

Issue

2

Start / End Page

594 / 604

Location

United States

Related Subject Headings

  • Prospective Studies
  • Personnel Selection
  • Mitral Valve Insufficiency
  • Middle Aged
  • Male
  • Intraoperative Period
  • Humans
  • Female
  • Esophagus
  • Echocardiography