How will you assess the success of repair of mitral valve repair per-operatively?
The ideal method to assess the success of repair of mitral valve repair per-operatively is to use Intraoperative TEE (transesophageal echocardiography). It gives excellent images and does not interfere with the sterility of the operating field. Newer scanners with live 3-D (4-D) reconstruction of images gives the ‘surgeon’s view’ both from the atrial and ventricular aspects. This makes assessment of residual mitral regurgitation very easy. Surgeon can even revise the repair if needed as the chest is still open. Now most cardiac anaesthesiologists are trained in getting good transesophageal images and surgeons are rapidly acquiring the skill to interpret live 3-D echocardiography images. Use of intraoperative TEE can obviate the need for re-do surgery a lot as detection of residual mitral regurgitation (and the success of repair of mitral valve!) is earlier during the course of surgery.
Intraoperative TEE gives additional information about the left ventricular function and the presence or absence of any new regional wall motion abnormalities.
The conventional method of assessment of MR (mitral regurgitation) after repair is by flushing fluid into the left ventricle and looking for regurgitation into left atrium. This can be now considered a very crude method compared to real time 4-D TEE imaging!