Diagnostic Value of Transthoracic and Transesophageal Echocardiography in the Assessment of Primary Mitral Valve Prolapse Associated with Severe Mitral Regurgitation

In the diagnosis and follow-up of the patients with mitral valve prolapse (MVP), criteria for transthoracic echocardiography (TTE) has been established. However, studies investigating the potential value of multiplane transesophageal echocardiography (TEE) over TTE in the assessment of the valvular and chordal structures, and valvular regurgitations in pts with MVP are limited. The purpose of this study is to compare TTE and multiplane TEE in the assessment of the morphology of mitral and tricuspid valve leaflets, and chordal structures, grades of valve prolapse and regurgitations in pts with primary classical MVP, and to investigate optimal TEE planes in which prolapsed leaflets, insertion of chordae to leaflets, and regurgitant jets were best visualised. Study population comprised 77 patients (M 50, F 27, mean age 45.8±16.8) with primary classical MVP and mitral regurgitation (~3) who were subjected to TTE and TEE, and also includes a subgroup pts who hed undergone a mitral valve surgery (MVS). Transthoracic echocardiography and TEE findings were concordant in detecting prolapsed leaflet(s). Anterior, posterior, anterop osterior and posteroanterior MVP were found in 1 (1.3%), 30 (38.9 %), 22 (28 .5 %) and 24 (31.1%) pts, respectively. Length and thickness of the mitral leaflets that were measured by TTE and TEE were not significantly different . Chordal rupture was detected in 26 pts (33.7%), and 17 (65.4%), 6 (23%) and 3 (11.5%) of them were associated with posterior, anterior and both mitral leaflets, respectively. In comparison to intraoperative (IO) findings , sensitivity, specificity, positive and negative predictive value (PV+, PV-), diagnostic accuracy (DA) of TEE were 100, 100, 100, 100% and for TTE were 63.6, 100, 100, 55.5, 75%, respectively. Although smail number of pts had undergone MVS, good correlation was found between TEE and IO assesmen ı. If TEE is taken as a gold standard for diagnosis of CR, including all pts who have not undergone surgery, sensitivity, specificity, PV (+), PV (-),and DA of TTE for CR was 69.2, 86.2, 72, 84.6, and 80.5 %, respectively. In multiplane TEE assessment, best planes for anterior mitral leaflet prolapse and associated MR. were found to be between O and 10, for posterior leaflet and MR were between 70° and 90° and for TV prolapse and tricuspid regurgitation (TR) between 20° and 60°. In 39 out of 77 pts (50.6%) degree of MR was found to be one degree greater with TEE than that with TTE, and conversely, 31 out of 52 pts (59.6%) TR degree was one degree sınaller than that ofTEE. We conclude that, both TTE and TEE are suitable to diagnose prolapsed mitral and tricuspid leaflet(s) similarly, but TEE is superior to TTE in the precise assessment of the leaflet and chordal morphology, grade of an eccentric MR and when chordal rupture of mitralleaflets are associated.