ASSESSMENT OF MITRAL REGURGITATION BY BIPLANE TRANSESOPHAGEAL COLOR DOPPLER FLOW MAPPING

To test the role of recently developed biplane transesophageal color Doppler echocardiography in the assessment of severity of mitral regurgitation, we examined 51 patients undergoing cardiac catheterization and left ventriculography. Transesophageal color Doppler flow imaging detected mitral regurgitation in all 32 patients proved to have this lesion. In 10 of 16 patients without mitral regurgitation by angiography, mitral regurgitation signals were detected by transesophageal color Doppler flow imaging. Thus, the sensitivity and specificity of transesophageal color Doppler echocardiography for the detection of mitral regurgitation were 100% and 38%, respectively. There was some correlation between the regurgitant jet area from the longitudinal plane and angiographic grading. An improved angiographic correlation was achieved with the regurgitant jet area from the transverse plane. The best correlation with angiography was obtained when the maximum regurgitant jet area from two planes (the greater of the two measurements, each from a different plane) was considered. There was a significant difference in the maximum regurgitant jet area between none and mild (p<0.01), mild and moderate (p<0.001), and moderate and severe (p<0.01) mitral regurgitation. The maximum regurgitant jet area of less than 1.5 cm2 predicted the angiographic grading as none with a sensitivity and specificity of 88% and 94%, respectively. The maximum regurgitant jet of between 1.5 and 4 cm2 predicted the angiographic grading as mild with a sensitivity and specificity of 82% and 95%, respectively. The maximum jet area of between 4 and 7 cm2 predicted moderate mitral regurgitation by angiography with a sensitivity and specificity of 100% and 95%, respectively, whereas the maximum jet area of more than 7 cm2 predicted severe mitral regurgitation with a sensitivity and specificity of 83% and 100%, respectively. Thus, biplane transesophageal color Doppler flow imaging is a useful technique that not only is highly sensitive in identification of mitral regurgitation but also provides an accurate estimation of its severity.