Paravalvular leak closure under intracardiac echocardiographic guidance

Abstract

Percutaneous paravalvular leak closure guided by ICE without the requirement of general anesthesia is feasible, safe, and associated with acceptable procedural success rates.

Multimodality Cardiac Imaging for Procedural Planning and Guidance of Transcatheter Mitral Valve Replacement and Mitral Paravalvular Leak Closure

“…The needle position is assessed in the mid-esophageal bi-caval view (superior-inferior) and short-axis view (anterior-posterior), and height can be confirmed in a 4-chamber view. Transseptal puncture for TMVR is usually performed in the infero-posterior portion of the fossa ovalis, or the ideal position as determined by pre-procedural CCTA analysis, which may be projected to real-time TEE via fusion imaging ( 50 ). Orthogonal bi-plane imaging and live 3D imaging can simultaneously display all four rims of the fossa ovalis and serve for confirmation ( Figures 6A,B ).…”

“…Although intracardiac echocardiography (ICE) procedural guidance has been well-described in the setting of left atrial appendage occlusion ( 55 , 56 ) and to a lesser degree in mitral balloon valvuloplasty and transcatheter aortic valve replacement ( 57 ), there are limited reports of ICE-guided TMVR or PVL closure ( 50 ). ICE from the right atrium is particularly limited in visualizing lateral mitral PVL defects, and ICE in the LA requires an additional transseptal puncture and its associated risk.…”

Three‐dimensional echocardiography in the evaluation and management of paravalvular regurgitation

“…In selected cases of post‐TAVR PVR, percutaneous closure can be successfully performed . Although TEE and fluoroscopy are the main modalities used for intra‐procedural monitoring and guidance, both TTE and intracardiac echo have been successfully utilized in anteriorly located aortic PVR …”

“…Because of the high operative mortality after redo surgery, percutaneous closure techniques became an appealing alternative in selected cases. Advances in cardiovascular imaging have improved our ability to identify PVR and facilitated successful percutaneous closure when needed . Evidence exists that successful PVR reduction is associated with lower cardiac mortality, enhanced functional status, and improvement of hemolytic anemia …”

Beyond the Third Dimension: Intracardiac Echocardiography—The Next Frontier for Cardiac Anesthesiologists

“…The use of ICE for procedural guidance has already been reported in percutaneous mitral interventions, paravalvular leak closures, mitral commissurotomies, transcatheter mitral valve replacements, transcatheter pulmonary valve replacements, transcatheter tricuspid valve repairs, and valve-in-valve implantations. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] ICE is also commonly used for patent foramen ovale and atrial septal defect closures, as it provides superior visualization of the atrial septum with increased patient comfort. 22,23 ICE will likely become a feasible alternative to TEE in many settings, and obviates the need for general anesthesia, endotracheal intubation, and the attendant risks.…”