FEASIBILITY OF ON-LINE TRANSOESOPHAGEAL ECHOCARDIOGRAPHY DURING BALLON MITRAL VALVULOPLASTY
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The aim of the study was to assess the feasibility of on-line transesophageal echocardiography (TEE) during balloon mitral valvuloplasty (BMV) and its possible value in guidance of transseptal puncture, balloon positioning and dilatation, immediate assessment of results and complications and deciding when to stop dilataiton. Fifty consecutive patients presented or referred to National Heart Institute suffering from symptoms of mitral stenosis (MS) (tight MS, mitral valve score <10, mitral valve area s' 1.0cm2 with grade <2/4 mitral regurge and absence of left atrial thrombi). 25 patients were operated and balloon dilatation was done under fluoroscopic guidance and considered as control group and 25 patients were operated and balloon dilatation was done under TEE as study group. It was found that, the study group showed signcant difference in total fluoroscopy and procedure time as well as incidence of sever complications as TEE guidance allowed easier detection of optimum site of septostomy, proper balloon positioning at mitral orifice thus allowing optimum dilatation and as early as possible detection of any resulting complication so knowing when to stop balloon dilatation after achieving optimum commissural splitting or to control easy complications. Conclusion: TEE is a useful adjunct to fluoroscopy for guidance and monitoring of patients during balloon mitral valvulopasty. Higher quality images of atrial septum and surrounding structures facilitate transseptal puncture and proper balloon positioning across mitral orifice, avoiding placement in left atrial appendage or pulmonary veins or entrapment in subvalvular apparatus. It also confirms successful dilatation immediately by detecting commissural separation and allowing detection of major complications as early as possible. TEE guidance proved to reduce fluoroscopy time and reduce incidence of complications during BMV.