Transesophageal doppler color flow imaging in the detection of native and Björk-Shiley mitral valve regurgitation

Abstract

Regurgitant blood flow of mitral valves was studied by transesophageal Doppler color flow echocardiographic imaging in 11 healthy volunteers (Group 1), 25 cardiac patients with a native mitral valve (Group 2), 10 patients with a normally functioning Björk-Shiley mitral prosthesis without clinical evidence of mitral regurgitation (Group 3) and 10 patients with angiography or surgical evidence of Björk-Shiley mitral valve regurgitation (Group 4). Holosystolic regurgitant color jets were classified as type I or type II. The data were compared with results obtained with precordial techniques, i.e., continuous wave and Doppler color flow echocardiographic imaging (Groups 1 to 4) and left ventricular angiography or surgery (Groups 2 and 4).In Group 1, transesophageal Doppler color flow imaging revealed no mitral regurgitant flow in 7 of the 11 patients and a type I jet in 4 patients that was detected in only 1 patient by precordial techniques. In Group 2, angiography showed no mitral regurgitation in 20 patients and documented mitral regurgitation in 5. Transesophageal Doppler color flow imaging detected in 4 of the 20 patients a type I jet that was not visualized with precordial techniques in 2 patients. Type 11 jets were detected by the transesophageal technique in all five patients with proven mitral regurgitation and were also visualized with precordial echocardiography. All patients in Group 3 showed two identical type I jets that were not detected with precordial echocardiography. In Group 4, transesophageal Doppler color flow imaging revealed a type 11 jet in all 10 patients and, in addition, a type I jet in 7; the precordial continuous wave and Doppler color flow techniques detected mitral regurgitation in 6 and 3 patients, respectively.From this study it is concluded that transesophageal Doppler color flow imaging is an extremely sensitive method for the detection of mitral regurgitation. The unique position of the transesophageal transducer behind the Björk-Shiley mitral prosthesis makes it the technique of choice for the evaluation of prosthetic mitral valve regurgitation.