Severe postoperative mitral regurgitation renders information on the underlying mechanism
before reoperation very important, as a potential for mitral valve reconstruction
may fa- cilitate the decision whether to reoperate, especially in the very young.
This study compares the efficacy of transthoracic echocardiography (TTE) and left-ventricular
angiography with that of transesophageal echocardiography (TEE) for detection of the
mechanism underlying mitral regurgitation and its quantitative assessment in children
after repair of common atrioventricular septal defect. Five children aged 1.5 to 16
years were evaluated by TTE, TEE, and angiography for postoperative mitral regurgitation
1 to 21 months after initial repair. TEE showed septal detachment of the mitral leaflet
in four patients and reopening of the mitral cleft in one patient as the cause of
mitral regurgitation whereas TTE failed in four and angiography in all patients. TEE
allows definite identification of morphologic characteristics of mitral regurgitation
and reliable assessment of its severity. Thus redo surgery may be safely performed
on the bases of TEE find ings alone without confirmation by cardiac catheterization.
Pulmonary venous blood flow - Systolic reversed flow - Mitral regurgitation - Atrioventricular
septal defect - Transesophageal echocardiography
