[Case in which transesophageal echocardiography after induction of anaesthesia was useful for reevaluation of preoperative diagnosis].

A woman in her 70's had undergone two valve replacements (mitral valve and aortic valve). A transendothelial chest wall echocardiogram (TTE) showed that a flap lobe of a mitral mechanical valve had fixed the valve in a closed state, and it was diagnosed as stuck leaflet of a bileaflet prosthesis in the mitral position. She was scheduled for emergency surgery for mitral valve replacement. After induction of anaesthesia, a transesophageal echocardiography (TEE) probe was inserted. Observation of two-dimensional images showed that the bileaflet mechanical valve in the mitral position was functioning properly. Pulsed wave Doppler measurements showed that maximum blood flow rate, pressure-half-time, maximum gradient and average gradient were 1.5 m x sec(-1), 64 ms, 9.0 mmHg and 3.5 mmHg, respectively, and there were no findings suggesting mitral stenosis. TEE showed that there was no stuck leaflet of the bileaflet prosthesis in the mitral position, and the operation was called off. The patient was followed up in the intensive care unit. In this case, TEE was useful for reevaluation of the preoperative diagnosis and for reevaluation of indication for surgery.