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Intraoperative assessment of mitral regurgitation: role of phenylephrine challenge.

Mihalatos DG, Gopal AS, Kates R, Toole RS, Bercow NR, Lamendola C, Berkay SH, Damus P, Robinson N, Grimson R, Shen K, Reichek N

St Francis Hospital-The Heart Center/Stony Brook University Hospital, Roslyn, New York 11576, USA. dgmecho@yahoo.com

OBJECTIVES: We defined the effects of the operative (OP) state and phenylephrine challenge on the assessment of mitral regurgitation (MR) severity. METHODS: In all, 57 patients underwent transesophageal echocardiographic assessment of MR severity pre-OP (PREOP) and intra-OP. MR severity was assessed PREOP under conscious sedation and intra-OP with general anesthesia, before and after hemodynamic manipulation with vasoactive agents, to match intra-OP and PREOP transesophageal echocardiographic mean arterial blood pressures. RESULTS: Intra-OP MR and mean arterial pressure were less than PREOP in 27 patients (both P < .001). When PREOP and OP blood pressures were matched using phenylephrine, there was no significant difference in MR severity between the two states (P = 1.0). Nonetheless, MR severity was still underestimated in 6 patients and overestimated in 7 patients intra-OP. CONCLUSIONS: Intra-OP transesophageal echocardiography underestimates MR severity. Phenylephrine reduces, yet does not eliminate, intra-OP underestimation of MR severity.

Published 4 September 2006 in J Am Soc Echocardiogr, 19(9): 1158-64.
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