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RESEARCH PRODUCT

Intraoperative Evaluation of the Reconstruction of the Atrioventricular Valves by Means of Transesophageal Echocardiography

subject

description

In 44 operations, the mitral valve was reconstructed in 28 patients, the tricuspid valve in 12, and both atrioventricular (AV) valves in four. The results of reconstruction were tested first in the open arrested heart by injection of a crystalloid solution into the left or right ventricle, either through the reconstructed valve or via one of the great arteries. Upon termination of cardiopulmonary bypass the valve function was examined in the beating heart by transesophageal contrast echocardiography (TEE). For purposes of visualization, 0.5–1.0 cc of agitated Gelifundol was injected into the ventricle. In 31 patients, open testing and echocardiographic visualization showed identical, good operative results. In 12 patients TEE revealed moderate and in two cases moderate to severe insufficiency that was not apparent on open testing, but no further surgery was done. In three patients undergoing mitral valve repair, contrast echocardiography showed severe insufficiency, which had not been detected during cardiac arrest and which could not be corrected by more extensive reconstruction. In these patients changes at the level of the subvalvular apparatus caused systolic dislocation of the leaflets and massive reflux. Because of these findings definitive valve replacement was performed in the same operation.