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LETTERS TO THE EDITOR

Additional View of the Mitral Valve

Gert Poortmans, MD^*, Guido Schüpfer, MBA, HSG, Carl Roosens, MD^*,, and J. Poelaert, MD, PhD^*,

*Postoperative Cardiac Surgical ICU and Department of Anesthesia University Hospital of Gent B-9000 Gent, Belgium Institut für Anästhesie und Intensivmedizin Kantonsspital Luzern CH-6000 Lucerne 16, Switzerland

Lambert et al. (1) published their systematic evaluation of the mitral valve by transesophageal echocardiography. We use a comparable approach to assess the mitral valve in patients scheduled for elective coronary artery bypass surgery with one additional imaging view, which allows the evaluation of the chordae tendineae. By rotating the transducer to 90° starting from a midshort-axis view in a transgastric position, a two-chamber view is produced. At the top of the screen, the posterior wall with the posteromedial papillary muscle is visualized and at the bottom of the screen, the anterior wall with the anterolateral papillary muscle can be seen (Figs. 1 and 2). Minimal probe movements allow accurate assessment of the chordae tendineae and their insertion at the margins of the mitral valve leaflets. Distinction can be made between the chordae from the posteromedial papillary muscle inserting on the medial and middle scallops of the posterior leaflet and those inserting on the medial and middle thirds of the anterior leaflet. Also distinction can be made between the chordae from the anterolateral papillary muscle inserting on the lateral and middle scallops of the posterior leaflet and those inserting on the lateral and middle thirds of the anterior leaflet (2).

View larger version (16K): [in this window] [in a new window]   Figure 1. Visualization of the mitral valve seen from the left atrium. MVPL = mitral valve posterior leaflet, MVAL = mitral valve anterior leaflet, PPM AL = anterolateral papillary muscle, PPM PM = posteromedial papillary muscle, ALC = anterolateral commisure, PMC = posteromedial commisure.

View larger version (21K): [in this window] [in a new window]   Figure 2. Short axis view at 90°. LV = left ventricle, LA = left atrium, CT = chordae tendineae, LVPW = left ventricular posterior wall, LVAW = left ventricular anterior wall, PPM AL = anterolateral papillary muscle, PPM PM = posteromedial papillary muscle, MVPL = mitral valve posterior leaflet, MVAL = mitral valve anterior leaflet.

1. Lambert AS, Miller JP, Merrick SH, et al. Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic transesophageal echocardiography examination. Anesth Analg 1999;88:1205–12.[Abstract/Free Full Text]
2. Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA Guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for certification in perioperative transesophageal echocardiography. Anesth Analg 1999;89:870–84.[Free Full Text]

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