Shah Zeb, Muhammad Irfan, Muhammad Asghar Khan, Nasir Ali, Ijaz Hussain, Abdul Hadi, Rifaq Zeb, Adnan Mahmood Gul.
Comparision of Transthoracic and Transesophageal Echocardiography in Evaluation of patients with Mitral Steosis for Percutaneous Transluminal Mitral Commissurotomy.
J Saidu Med Col Jan ;8(2):117-21.

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.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com