Intraoperative echocardiographic studies of the mitral valve: assessment of commissurotomy and repair.

Mitral echocardiograms obtained by direct application of the ultrasonic probe to the epicardial surface were compared with echocardiograms obtained by the conventional chest surface technique in 32 patients. The groups comprised 16 patients with stenosis, nine with incompetence, and seven patients with normal mitral valves. In every patient, prior to the exploration of the mitral valve, echocardiograms were obtained from the surface of the chest and from the epicardial surface of the heart. In 13 patients, direct epicardial and chest surface echocardiograms were repeated after mitral valvotomy or repair. The initial mitral valve lesion in these patients was stenosis in seven and incompetence in six. The diastolic closure rates (E-F speed) obtained by direct epicardial surface echocardiography revealed a significant statistical correlation (P less than 0.001) which was comparable to that recorded from the chest surface. This technique offers a further means of detecting residual mitral stenosis, before closure of the chest, after commissurotomy or repair.