Transesophageal ECHO and the Mitral Valve

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Transesophageal ECHO and the Mitral Valve
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Anesth Analg 199988120512.
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Am Heart J. 2000139 378-87.
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Fibrous Skeleton Of The Heart
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Anatomic Classification Schema Mitral Valve
Segments
Duran Classification
Ann Thorac Surg 1998 651025-1031. J Heart Valve
Dis 1995 470-75. Cardiol Clin. 2000 18
731-50.
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JASE. 2003 16 61 66.
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• Mid-esophageal 4C View
• A3 and A1
• Commisural View
• P3-A2-P1
• Two Chamber View
• P3-A1
• Long Axis View
• A2
• Transgastric Views (Short)
• Posteromedial commissure
• Anterolateral commissure
• Transgastric Views (Long)
• Chordae Tendinae
• Papillary Muscle

Assessment of the Mitral Valve
JASE. 2003 16 61 66.
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Mid-esophageal Views (Transducer _at_ 0)
Anesth Analg 199988120512.
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Four Chamber Views Isolating Mitral Valve
Leaflet Segments
Cardiol Clin. 2000 18 731-50.
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Four Chamber View
Crit Care Clin. 1996 12 321-81.
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Mid-esophageal Views (Transducer _at_ 60)
Anesth Analg 199988120512.
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Two Chamber Views Isolating Mitral Valve
Leaflet Segments
Cardiol Clin. 2000 18 731-50.
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Two Chamber Posterior View
Crit Care Clin. 1996 12 321-81.
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Apical Long Axis View
Cardiol Clin. 2000 18 731-50.
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Commissural View
JASE. 2003 16 61 66.
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Commissural View
JASE. 2003 16 61 66.
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Transgastric Views (Transducer _at_ 0)
Anesth Analg 199988120512.
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Transgastric Long-axis View Visualization of the
Papillary Muscles
Posteromedial Papillary Muscle
Anterolateral Papillary Muscle
Cardiol Clin. 2000 18 731-50.
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Accuracy of Transesophageal Echocardiographic
(TEE) Diagnosis in Determination of Affected
Flail Leaflet
JASE.199811966-71.
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Accuracy of Transesophageal Echocardiographic
Diagnosis of Affected Scallop Among Patients
With Posterior Flail Mitral Leaflet
JASE.199811966-71.
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Diagnostic Accuracy of Identification of Mitral
Regurgitant Defects by Correlation withSurgical
Findings

• Defect Location Sensitivity () Specificity ()
• A1 97.1 98.3
• A2 96.3 97.7
• A3 98.5 97.9
• P1 98.7 97.8
• P2 99.6 92.4
• P3 94.7 96.9

JASE. 2003 16 61 66.
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JASE.199811966-71.
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Pathologic Anatomic Changes to Assess During
Transesophageal Echocardiographic Examination of
the Mitral Valve
Mitral Annulus

• Calcification
• Dilatation
• Perivalvular Leak
• (Prosthetic Valves)

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Midesophageal View of the Mitral Valve Mitral
Annular Calcification
Cardiol Clin. 2000 18 731-50.
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Circulation. 2000101695.
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Mitral Leaflets

• Billowing leaflet
• Coaptation level of anterior and posterior
  leaflet relative to annulus
• Systolic anterior motion of anterior leaflet
• Leaflet thickening
• Leaflet fusion (rheumatic) doming of fused
  leaflets in diastole (mitral stenosis)
• Calcification of leaflets
• Prolapse
• Deformation of leaflet free margin    
• Thickening, retraction of free margin into
  ventricle (curling under)
• Endocarditis    
• Vegetation, leaflet aneurysm, perforation,
  associated regurgitant jet of aortic
  insufficiency hugging ventricular side of
  anterior leaflet (possible source of infectious
  seeding)

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Circulation. 20001021400.
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Apical Displacement of Mitral Coaptation (aka
Tenting)
Circulation. 20001021400.
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Mitral Valve Prolapse
Diagnostic Criteria

• Classic MVP
• Displacement gt 2 mm
• Thickness 5 mm
• Non-Classic MVP
• Displacement gt 2 mm

Cardiol Clin. 2000 18 731-50.
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Atrial Views of Prolapse of the Anterior Mitral
Valve Leaflet
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Chordae

• Chordal systolic anterior motion
• Thickening
• Fusion
• Calcification
• Elongation
• Rupture

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Posterior Mitral Leaflet Prolapse (Flail
Posterior Leaflet) Ruptured Chord
Cardiol Clin. 2000 18 731-50.
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Papillary Muscles

• Ruptured papillary muscle
• LV-papillary muscle dysfunction

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Subtotal Ruptured Papillary Muscle
Cardiol Clin. 2000 18 731-50.
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Miscellaneous

• Miscellaneous Findings
• Left atrial enlargement
• Atrial appendage thrombus,
• LV dilation/aneurysm,
• TV annulus dilation,
• tricuspid regurgitation,
• right ventricular enlargement

• Systolic anterior motion
• Mitral valve repair
• Narrow LVOT
• Small LV diameter
• Increased anterior and posterior leaflet area

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Post-Operative Assessment Residual Mitral
Regurgitation
Am Heart J. 1996 131 162-76.
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Post-Operative Assessment Residual Mitral
Regurgitation
Cardiol Clin. 1998 16 477-89.
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Post-Operative Assessment Exclude Systolic
Anterior Motion of the Mitral Valve
Crit Care Clin. 1996 12 321-81.
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Post-Operative Assessment Exclude Mitral Stenosis
Crit Care Clin. 1996 12 321-81.
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Anesth Analg 199988120512.