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. |
