Original article Value of transesophageal dobutamine stress echocardiography for selection of the type of cardiac surgery in significant ischaemic mitral insufficiency

Abstract

Background: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy. Aim: To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm2) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus. Methods: The study group comprised 212 pts (M/F – 134/78; mean age 65±10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8±0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I – 7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery. Results: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I – small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II – small 15/14/13, moderate 2/3/3, severe 0/0/0. Conclusions: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.