Registered Cardiovascular Invasive Specialist (RCIS) Practice Test

Why is a TEE necessary before mitral valvuloplasty?

1. To check for pulmonary hypertension

2. To assess the size of the atrium

3. To detect atrial thrombus

4. To measure left ventricular function

The correct answer is: To detect atrial thrombus

A transesophageal echocardiogram (TEE) is particularly crucial before mitral valvuloplasty due to its ability to provide detailed imaging of the heart structures, especially the left atrium. One key reason for performing a TEE is to detect the presence of an atrial thrombus. Atrial fibrillation is often associated with mitral valve disorders, leading to the potential formation of blood clots in the left atrium, particularly in the appendage. If a thrombus is present and the mitral valvuloplasty proceeds without addressing it, there's a significant risk of embolization, which could result in stroke or other serious complications. By utilizing TEE, clinicians can visualize and confirm the absence of thrombus before the procedure, ensuring patient safety and optimizing outcomes. While factors like pulmonary hypertension, left atrial size, and left ventricular function are important considerations in the overall assessment and management strategy for mitral valve interventions, they are secondary to the immediate concern of safely identifying and managing potential thrombotic complications. Thus, the primary utility of a TEE in this scenario is to confirm or rule out the presence of an atrial thrombus, making it a critical step before proceeding with mitral valvuloplasty.