Transthoracic and transesophageal echocardiography pre and post percutaneous mitral catheter balloon valvulotomy.

Catheter balloon valvulotomy (CBV) is useful in the relief of rheumatic mitral stenosis. Morphologic scoring of the mitral valve by transthoracic echocardiography is predictive of success with CBV. Horizontal plane transesophageal echocardiography can obtain high quality images of the mitral valve and left atrium, but its value with routine use in the pre and post CBV setting is unknown. We prospectively examined 14 patients with mitral stenosis, pre and post CBV, noting scores, complications of mitral stenosis, and complications of CBV. Mitral valve scoring was similar by TTE and TEE pre and post CBV, but TEE did tend to underestimate scores pre CBV. There was a single thrombus, it was detected only by TEE. Post CBV, both TTE and TEE detected one of two torn chordae. Of three patients with ASD's by colour flow mapping, TTE and TEE each detected two. Increases in mitral insufficiency post CBV were seen equally frequently by TTE and TEE. The increases appeared to be of a higher grade (NS) by TEE. TTE and TEE yielded complementary findings, pre and post CBV. Other than for the detection of thrombi through, the net clinical contribution of routine use of TEE appears small, and large series would be needed to establish its contribution.