The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 573-579, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Intraoperative contrast two-dimensional echocardiography. Evaluation of the presence and severity of aortic and mitral regurgitation during cardiac operations
MG Eguaras, J Pasalodos, V Gonzalez, A Montero, MA Garcia, I Moriones, J Granados, F Valles and M Concha
We have used contrast two-dimensional echocardiography in the
intraoperative evaluation of aortic and mitral regurgitation in 35 patients
undergoing cardiac operations. All of them underwent previous cardiac
catheterization in order to document the presence and severity of
regurgitation. With the pericardium open, a catheter was introduced into
the left ventricle (to document mitral regurgitation) or into the ascending
aorta (to document aortic regurgitation). The two-dimensional
echocardiographic probe was placed on the anterior surface of the right
ventricle to obtain a basal image, equivalent to a conventional parasternal
longitudinal view. Dextrose in water (5 ml) was rapidly hand-injected
through the catheter, while echocardiograms were recorded on videotape. The
observation of contrast medium (microbubbles) flowing in the retrograde
direction through the incompetent valve was carefully evaluated with the
same scoring system used in the hemodynamic laboratory. In 34 cases there
was agreement between angiographic and echocardiographic evaluation of the
presence and severity of mitral and aortic regurgitation. Only one case was
evaluated as mild aortic regurgitation by angiography and moderate aortic
regurgitation by echocardiography. There were no false positives or false
negatives in the study. In view of the high degree of correlation between
contrast two-dimensional echocardiography and hemodynamic data, we suggest
that our method is an important tool for the cardiac surgeon. In addition,
the present approach overcame the disadvantages of the conventional
intraoperative methods, most of which are performed in a nonbeating or
fibrillating heart.