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This chapter deals with mitral valve (MV) disease. Mitral stenosis is obstruction of left ventricular inflow at the level of the MV, as a result of structural abnormalities of the MV apparatus that limit proper opening during diastole. Mitral annular calcification is a degenerative process, and is a common incidental finding in the elderly. Rheumatic carditis is the commonest cause of mitral stenosis in both developed and developing countries. Mitral regurgitation (MR) is the most commonly encountered valvular lesion in modern clinical practice. Primary MV prolapse syndrome (MVPS) refers to a disease spectrum with frank myxomatous degeneration at one extreme. The transesophageal echocardiography (TEE) variables used in the assessment of MR severity can be classified as semi-quantitative or quantitative. The vena contracta (VC) refers to the narrowest portion or neck of the regurgitant jet, which occurs at or just beyond the regurgitant orifice.
Over the past decade there has been a dramatic increase in the use of transoesophageal echocardiography (TOE) in the perioperative setting among all disciplines caring for the cardiac patient. Where TOE used to be used mainly by cardiologists in the echocardiography laboratory, we now recognize its value in the operating theatre, cardiac catheter laboratory, and intensive care unit. TOE has become the gold standard perioperative cardiac monitor and diagnostic tool for certain cardiac surgical procedures. Its role has also been extended to critically ill or unstable patients for non-cardiac procedures and the general intensive care arena. The increasing involvement of anaesthetists and of other specialities at an advanced level has promoted the team approach to perioperative patient care. The rapid advances in the use of this technology have also resulted in a critical need for interdisciplinary training.
The development of training and certification in echocardiography has been a long and intensive process in Europe and the USA. Excellent comprehensive TOE courses have been available and working groups on TOE have published extensive practice and training guidelines on both sides of the Atlantic and in Japan. The American Society of Cardiovascular Anesthesiologists (SCA) developed the first formal examination in perioperative TOE in 1998. The SCA and the American Society of Echocardiography (ASE) then combined forces to establish the National Board of Echocardiography (NBE), which had the responsibility to further administer examinations and develop a certification process in clinical echocardiography.
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