Perioperative assessment of left ventricular function in patients with mitral valve stenosis undergoing mitral valve replacement: Utility of Tei index and ejection fraction

Background & objectives: In the presence of mitral stenosis, LV conditions are modified with a trend to decrease preload and increase afterload. Under these hemodynamic conditions, the assessment of myocardial contractility by ejection phase measurements may be inappropriate, as these are well known to be influenced by acute changes in loading conditions. Tei index expressing global cardiac function has been reported as unchanged after mitral valve surgery. The hypothesis was tested where the Tei index could be useful in assessing the perioperative cardiac function in mitral stenosis patients undergoing mitral valve replacement. Methodology: Transesophageal echocardiography was performed in 50 Mitral Stenosis patients before and after mitral valve replacement. Ejection fraction (calculated from LV end-diastolic and end-systolic areas obtained through the transgastric mid short-axis view) and Tei index (calculated from the mid-oesophageal four-chamber view and the deep transgastric long-axis view) was compared in these patients. Results: In this study, the difference between pre-operative and post-operative Tei Index was statistically not significant while the difference between pre-operative and post-operative Ejection fraction was statistically significant. Conclusion: Unlike ejection fraction, Tei index is not influenced by mitral valve replacement. Tei index is a better parameter to assess left ventricular function.