Transesophageal echocardiography, or TEE, is not indicated in our patient. It may be indicated in patients with mitral valve prolapse prior to anticipated mitral valve surgery or those in whom endocarditis is suspected. In patients with significant mitral regurgitation TEE provides 1) a closer look at the leaflets to determine which scallop is primarily involved; 2) better quantification of the degree of mitral regurgitation, especially using pulmonary vein flow analysis; 3) identification of complications such as flair leaflet and endocarditis; and 4) monitoring valve surgery intraoperatively, especially with mitral valve repair. Examples of some of these findings follows.
TEE prolapsed scallops - MV level long axis plane
This is a systolic still-frame of a 2-dimensional transesophageal echocardiogram in the long axis plane at the level of the mitral valve from another patient. Two of the three scallops of the anterior mitral leaflet, A2 and A3, and one of the three scallops of the posterior leaflet, P2, are well visualized. In systole, these three scallops prolapse posteriorly into the left atrium. In the real-time study that follows, note that the abnormal anterior and posterior scallops bulge posteriorly into the left atrium during systole. The anterior and posterior leaflets coapt at end systole, ruling out a flail leaflet.
TEE flail PML - MV level 2-chamber plane
This is a systolic still-frame of the two dimensional echocardiogram in the 2-chamber plane at the level of the mitral valve. from another patient. The posterior mitral leaflet is thickened and flail, that is, in systole it protrudes into the left atrium with its chordal tips pointing away from the left ventricle, because chordae supporting the leaflet have ruptured. Also apparent is failure of the anterior leaflet to coapt with the posterior leaflet. In the real-time study that follows, note the flail leaflet in the left atrium during systole as well as the freely mobile ruptured chordae.
TEE flail PML severe MR - MV level 4-chamber plane
These are systolic still-frames of 2-dimensional transesophageal echoes in the 4-chamber plane at the level of the mitral valve from another patient. The echo on the left shows the flail posterior mitral leaflet in the left atrium. The echo on the right shows a large eccentric cyan color jet of severe mitral regurgitation directed towards the anterior anterior wall of the left atrium, as would be expected with a flail posterior mitral leaflet. In the real-time study that follows, the echo on the left shows the movements of the flail posterior mitral leaflet into the left atrium with its tip unattached to the torn chordae pointing towards the posterior left atrial wall. On the right, the large and eccentric systolic cyan color jet of mitral regurgitation enters the left atrium and is directed anteriorly.