medigraphic.com
ISSN 2448-5640 (Print)
Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2017, Number 2

Next >>

Cir Card Mex 2017; 2 (2)

Correlación entre la ecocardiografía transtorácica preoperatoria y los hallazgos quirúrgicos en la cirugía valvular mitral

García-Villarreal OA

Language: Spanish
References: 17
Page: 43-48
PDF size: 219.81 Kb.


ABSTRACT

Objective. To show the preoperative trans-thoracic echocardiography effectiveness regarding to feasibility rate of mitral valve repair.
Material and Methods. We analyze 38 patients undergone mitral valve surgery from september 2015 to june 2016. Intraoperative findings were confronted against those others obtained by preoperative trans-thoracic echocardiography.
Results. Mean age was 56.7 ± 13.4 year-old. Rheumatic disease was the main ethiology (65.8%), follwed by degenerative disease (21.1%). The most important findings here were the lack of correlationship between peoperative trans-thoracic echocardiography and intraoperative findings for the IIIa funcitonal type (20 vs 25, p ‹ 0.01; sensibility 100%, specificity 72.2%, positive predictive value 80%, negative predictive value 100%). In cases of involved posterior leaflet 6 vs 9, p ‹ 0.01, sensibility 100%, specificity 90.6%, positive predictive value 66.7%, negative predictive value 100%. Positive feasibility was 8 vs 10, p ‹ 0.01, sensibility 100%, specificity 93.3%, positive predictive value 80%, negative predictive value 100%.
Conclusions. At present in our institution, preoperative trans-thoracic echocardiography is not useful in order to take a preoperative decision-making on mitral valve repair. Special emphazise must be done in cases with P2 prolapse, which can be considered for prophylactic valve repair before sympthoms. On the other hand, echocardiography is very safe showing the most likely ethiology according the morphology of the mitral valve.


REFERENCES

  1. Nishimura RA, Otto CM, Bonow RO, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACCguideline for the management of patients with valvular heart disease: executivesummary: a report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2438-2488.

  2. Enriquez-Sarano M, Sundt T. Early Surgery Is Recommended for Mitral Regurgitation.Circulation 2010;121:804-812.

  3. Carpentier, A. La valvuloplastie reconstructive. Une nouvelle technique de valvuloplastiemitrale. Presse Med. 1969;77:251–256.

  4. Carpentier, A. Cardiac valve surgery—“The French Correction”. J Thorac CardiovascSurg 1983;86:323–337.

  5. Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographicassessment of native valvular regurgitation: an executive summaryfrom the European Association of Cardiovascular Imaging. European Heart Journal– Cardiovascular Imaging 2013;14:611–644.

  6. Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, et al; MIDA investigators.Twenty-Year Outcome after Mitral Repair Versus Replacement for SevereDegenerative Mitral Regurgitation. Analysis of a Large, Prospective, MulticenterInternational Registry. Circulation 2016 Nov 29. pii: CIRCULATIONAHA.116.023340.

  7. Silaschi M, Chaubey S, Aldalati O, et al. Is Mitral Valve Repair Superior to MitralValve Replacement in Elderly Patients? Comparison of Short- and LongTerm Outcomes in a Propensity-Matched Cohort. J Am Heart Assoc 2016 Jul28;5(8):e003605 doi: 10.1161/JAHA.116.003605) (1-11)

  8. David TE. Durability of mitral valve repair for mitral regurgitation due to degenerativemitral valve disease. Ann Cardiothorac Surg 2015;4:417-421.

  9. Monin JL, Dehant P, Roiron C, et al. Functional assessment of mitral regurgitationby transthoracic echocardiography using standardized imaging planes diagnosticaccuracy and outcome implications. J Am Coll Cardiol 2005;46:302-309.

  10. Correia PM, Coutinho GF, Branco C, Garcia A, Antunes MJ. Surgical Treatmentof Posterior Mitral Valve Prolapse: Towards 100% Repair. J Heart Valve Dis2015;24:752-759.

  11. Stewart WJ, Currie PJ, Salcedo EE, et al. Intraoperative Doppler color flow mappingfor decision-making in valve repair for mitral regurgitation. Technique andresults in 100 patients. Circulation 1990;81:556-566

  12. Stewart WJ, Salcedo EE, Cosgrove DM. The value of echocardiography in mitralvalve repair. Cleve Clin J Med 1991;58:177-183.

  13. Pieper EP, Hellemans IM, Hamer HP, et al. Additional value of biplane transesophagealechocardiography in assessing the genesis of mitral regurgitation andthe feasibility of valve repair. Am J Cardiol 1995;75: 489-93.

  14. Minardi G, Pino PG, Manzara CC, et al. Preoperative scallop-by-scallop assessmentof mitral prolapse using 2D-transthoracic echocardiography. CardiovascularUltrasound 2010, 8:1 doi:10.1186/1476-7120-8.

  15. Medina MC. Generalidades de las pruebas diagnósticas, y su utilidad en la tomade decisiones médicas. Rev Colomb Psiquat 2011;40:787-797.

  16. Müller S, Müller L, Laufer G, et al. Comparison of three-dimensional imagingto transesophageal echocardiography for preoperative evaluation in mitral valveprolapse. Am J Cardiol 2006;98: 243-248.

  17. Gutiérrez-Chico JL, Zamorano Gómez JL, Rodrigo-López JL, et al. Accuracy ofreal-time 3-dimensional echocardiography in the assessment of mitral prolapse. Istransesophageal echocardiography still mandatory? Am Heart J 2008;155:694-698.




2020     |     www.medigraphic.com