Comparision of Transthoracic and Transesophageal Echocardiography in Evaluation of Patients with Mitral Steosis for Percutaneous Transluminal Mitral Commissurotomy

Abstract

Background: Percutaneous transluminal mitral commissurotomy is indicated for suitable severe mitral stenosis patients. Mitral
valve is assessed with transthoracic echocardiography (TTE) and transesophageal echocardiography for suitability of
Percutaneous Transluminal Mintral Commissurotomy procedure. This study is performed to evaluate TTE &TEE for mitral valve
assessment.
Objectives: To compare transthoracic and transesophageal echocardiography in evaluation of patients with mitral stenosis for
percutaneous transluminal mitral commissurotomy.
Material and Methods: This observational comparative study was performed in Cardiology department of Lady Reading Hospital
Peshawar from January 2011 to December 2012. All patients with rheumatic mitral stenosis were evaluated for PTMC both on
transthoracic (TTE) and transesophageal echocardiography (TEE).All analysis were performed on SPSS 16.The continuous
variables were reported as mean ±SD while the categorical variables were reported as percentages. The chi square test was used
for continuous variables while student t test was used for numeral variables.
Results: The total number of patients studied were 141. Of these patients 44/141(31.2%) were male and 97/114(68.8%) were
female. Mean age was 28.21±5.86.Atrial fibrillation was documented in 47(33%) patients. Grade 1 mitral valve thickness was seen
in 1(0.7%) patient on TTE vs 2(1.4%) on TEE, graded 2 is seen in 11(7.8%) patients on TTE as compare to 10(7.1%) on TEE,
graded 3 is seen in 122(86.5%) patients on TTE and TEE both, graded 4 is seen in 7(5%) patients both on TTE and TEE. Similarly,
mitral valve mobility of different grades were best assessed by TEE as compare to TTE (p value 0.01). Grade 3 calcification was
seen in 5(3.5%) on TTE as compare to 10(7.1%) patients on TEE while grade 4 was seen in 3(2.1%) patients on TEE while in none
on TTE (P valve0.01). There was also significant difference in subvalvular thickness assessment on TTE and TEE (P valve0.005).
LA/LAA clot was seen in 59(41.1%) patients on TEE as compare to 2(1.4%) patients on TTE(P valve 0.001). spontaneous echo
contrast was seen in 6(4.3%) patients on TTE as compare to 134(95%) on TEE(P valve0.001). Also mitral regurgitation severity
assessment was best done by TEE as compare to TTE (P valve0.001).
Conclusion: Transesophageal echocardiography is better than transthoracic echocardiography for periprocedural evaluation of
mitral stenosis patients for PTMC in term of mitral valve apparatus thickening, calcification, and quantification of mitral
regurgitation, spontaneous contrast echo and left atrial appendage visualization.
Key Words: Mitral stenosis, transthoracic echocardiography, transesophageal echocardiography, percutaneous transluminal
mitral commissurotomy, Wilkinscore