Case 4--2000. A systematic approach to intraoperative transesophageal echocardiographic evaluation of the mitral valve apparatus with anatomic correlation.

Mitral valve repair is the established and preferred surgical treatment of myxomatous mitral valve disease. Numerous reports have shown the superiority of repair versus replacement in terms of operative mortality, thromboembolism, and longterm survival.l.2 Repair places greater demands on the surgeon, who is no longer satisfied with the standard preoperative data but requires precise anatomic details to direct specific repair maneuvers. Transesophageal echocardiography (TEE) of the beating heart provides more precise and reliable functional information than the direct visual observation of the valve in the arrested cardioplegic heart) A systematic intraoperative TEE examination of the mitral valve apparatus is described with the aim of providing the surgeon with a road map of the mitral valve using landmark midesophageal and ventricular TEE views. The following discussion reviews anatomy of the mitral valve apparatus and relates it to these landmark TEE views. The mitral valve nomenclature proposed by Kumar et al 4 is used (Fig 1). This mitral valve nomenclature is based on the following: