Discrepancy Between Intraoperative Transesophageal Echocardiography and Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Surgery

Osami Honjo, Yasuhiro Kotani, Satoru Osaki, Yasufumi Fujita, Takanori Suezawa, Atsushi Tateishi, Kozo Ishino, Masaaki Kawada, Teiji Akagi, Shunji Sano

Research output: Contribution to journalArticle

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Abstract

Background: The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair. Methods: Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months). Results: Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 ± 0.8 versus 1.4 ± 0.9; p <0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 ± 0.8 versus 1.1 ± 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients. Conclusions: There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.

Original languageEnglish
Pages (from-to)2240-2246
Number of pages7
JournalAnnals of Thoracic Surgery
Volume82
Issue number6
DOIs
Publication statusPublished - Dec 2006

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Transesophageal Echocardiography
Echocardiography
Aortic Valve
Aortic Valve Insufficiency
Pathologic Constriction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Discrepancy Between Intraoperative Transesophageal Echocardiography and Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Surgery. / Honjo, Osami; Kotani, Yasuhiro; Osaki, Satoru; Fujita, Yasufumi; Suezawa, Takanori; Tateishi, Atsushi; Ishino, Kozo; Kawada, Masaaki; Akagi, Teiji; Sano, Shunji.

In: Annals of Thoracic Surgery, Vol. 82, No. 6, 12.2006, p. 2240-2246.

Research output: Contribution to journalArticle

Honjo, Osami ; Kotani, Yasuhiro ; Osaki, Satoru ; Fujita, Yasufumi ; Suezawa, Takanori ; Tateishi, Atsushi ; Ishino, Kozo ; Kawada, Masaaki ; Akagi, Teiji ; Sano, Shunji. / Discrepancy Between Intraoperative Transesophageal Echocardiography and Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Surgery. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 6. pp. 2240-2246.
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abstract = "Background: The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair. Methods: Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months). Results: Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 ± 0.8 versus 1.4 ± 0.9; p <0.01), and agreement between the two examinations was found in 12 patients (38{\%}). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 ± 0.8 versus 1.1 ± 0.9), and complete agreement in regurgitation grade was found in 5 (56{\%}) of 9 patients. Conclusions: There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.",
author = "Osami Honjo and Yasuhiro Kotani and Satoru Osaki and Yasufumi Fujita and Takanori Suezawa and Atsushi Tateishi and Kozo Ishino and Masaaki Kawada and Teiji Akagi and Shunji Sano",
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T1 - Discrepancy Between Intraoperative Transesophageal Echocardiography and Postoperative Transthoracic Echocardiography in Assessing Congenital Valve Surgery

AU - Honjo, Osami

AU - Kotani, Yasuhiro

AU - Osaki, Satoru

AU - Fujita, Yasufumi

AU - Suezawa, Takanori

AU - Tateishi, Atsushi

AU - Ishino, Kozo

AU - Kawada, Masaaki

AU - Akagi, Teiji

AU - Sano, Shunji

PY - 2006/12

Y1 - 2006/12

N2 - Background: The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair. Methods: Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months). Results: Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 ± 0.8 versus 1.4 ± 0.9; p <0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 ± 0.8 versus 1.1 ± 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients. Conclusions: There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.

AB - Background: The purpose of this study was to investigate the discrepancy between intraoperative transesophageal and postoperative transthoracic echocardiography in assessing residual regurgitation in children undergoing valve repair. Methods: Forty-two consecutive children (median age, 5.1 years) who underwent valve repair for valvar regurgitation from 2001 to 2004 were retrospectively analyzed. The patients were divided into two groups: atrioventricular valve group (n = 33) and aortic valve group (n = 9). Regurgitation grade, fractional shortening, and atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography were compared with those obtained by transthoracic echocardiography at discharge (median, 11 days) and at follow-up (median, 8 months). Results: Intraoperative transesophageal echocardiography revealed specific residual lesions in 4 patients, leading to successful re-repair. Fractional shortening obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the atrioventricular valve group, the regurgitation grade obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (0.7 ± 0.8 versus 1.4 ± 0.9; p <0.01), and agreement between the two examinations was found in 12 patients (38%). Peak atrioventricular inflow velocity obtained by intraoperative transesophageal echocardiography was lower than that obtained by predischarge transthoracic echocardiography (p <0.01). In the aortic valve group, there was no significant difference between the regurgitation grades in the two examinations (0.8 ± 0.8 versus 1.1 ± 0.9), and complete agreement in regurgitation grade was found in 5 (56%) of 9 patients. Conclusions: There were considerable discrepancies between the examinations in evaluation of residual atrioventricular valve regurgitation and potential atrioventricular valve stenosis: most of the residual regurgitations were underestimated by intraoperative transesophageal echocardiography. In contrast, reasonable agreement was found between the two examinations in evaluation of aortic valve regurgitation.

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