Comparision of Regurgitant Jet Size by Transesophageal Versus Transthoracic Doppler Color Flow Imaging

Doppler color flow imaging by transthoracic (TT) approach for the assessment of valvular regurgitation is a well-established noninvasive method. According to recent reports the transesophageal (TE) technique is considered to be more reliable for this purpose. In order to reassess this view, we compared the maximal regurgitant jet areas of 34 patients derived from Doppler color-flow imaging by either TT or TE approach. Whereas 56 regurgitant lesions were visualized by TE flow imaging (31 mitral, 13 aortic, 28 tricuspid jets), TT yielded fewer regurgitant lesions for each valve (26 mitral, 10 aortic, 20 tricuspid) (p<0.001). Moreover visual grading of individual valve lesions with each technique revealed a higher grade of regurgitation, whether classified as mild (32 versus 34), moderate (22 versus 18), or severe (18 versus 4), by TE than by TT imaging. Although maximal jet areas were significantly greater in TE technique (TE jet areas: 5.4±2.7 m2, TT jet areas: 2.9±1.6 cm2, p<0.001), there was a good overall correlation between the two approaches (r=0.76, TE=1.2 TT + 1.7, p<0.001). In conclusion, despite the lack of angiographic examinations comparing our results, the TE technique appears more sensitive than the TT technique for the assessment of valvular regurgitation.