Intraoperative transesophageal echocardiography--an indispensable tool in valve reconstruction and congenital anomalies.

Transesophageal echocardiography (TEE) with color flow mapping has become an excellent tool for evaluating valve reconstruction and correction of congenital anomalies intraoperatively. From February 1990 to September 1990 we have utilized TEE intraoperatively in 14 consecutive patients. Their ages ranged from 25 to 77 years, with a mean age of 58.7 years. There were eight males and six females. Twenty-one pathological entities were identified intraoperatively: mitral regurgitation due to posterior leaflet pathology in four; anterior leaflet pathology in four; annular dilatation in two; left to right shunt at the atrial level in five (two with partial anomalous pulmonary venous drainage); aortic regurgitation in two; and one patient each with ostium primum septal defect, Ebstein's anomaly, hypertrophic obstructive cardiomyopathy (HOC), and aortic stenosis. Based on intraoperative TEE findings, corrective procedures included quadrangle resection posterior leaflet with Carpentier ring in four, chordal shortening and chordal transfer anterior leaflet in four, flexible Duran ring for annular dilatation in two, closure of all atrial septal defects (ASD) with pericardial patch in secundum and sinus venosis type (ligation of small anomalous vein in one), and Dacron patch in primum type, myomectomy for HOC and reconstruction of the tricuspid annulus with Duran ring in Ebstein's anomaly. Two patients with associated coronary artery disease had coronary bypass grafting done. Following mitral valve repair TEE demonstrated trivial to no mitral regurgitation in eight (seven with repair) and mild regurgitation in one patient. All patients with closure of the ASD had an intact septum. The gradient in HOC was reduced significantly and there was satisfactory anatomical reattachment of the tricuspid annulus in Ebstein's anomaly.(ABSTRACT TRUNCATED AT 250 WORDS)