Percutaneous closure of paravalvular mitral regurgitation with Vascular Plug III under the guidance of real-time three-dimensional transesophageal echocardiography

Abstract

Transcatheter closure of mitral prosthetic paravalvular leak (PVL) has been hampered by technical challenges and the lack of closure devices specifically designed for this purpose. The oblong cross-sectional shape of the Amplatzer Vascular Plug III device (AVP) may be a more appropriate choice to be deployed for mitral PVL's. Real-time three-dimensional transesophageal echocardiography (RT-3D TEE) has emerged as an efficient tool that provides essential information concerning leakage size, location, and shape as well as navigation of catheters and wires. We assessed the feasibility and short, mid, and long-term efficacy of transcatheter mitral PVL closure using AVP-III under the guidance of RT-3D TEE. Three patients with severe symptomatic mitral PVL at high risk for repeat surgery underwent transcatheter leak closure with AVP III. Transfemoral approaches were used under RT-3D TEE guidance. Transcatheter closure of mitral PVLs was performed successfully in 3 patients using 5 devices. The first patient with 2 devices deployed had residual mitral regurgitation resulting in re-operation at the sixth month. The second patient had improved normally with a functioning prosthesis after the deployment of two devices, but had progressively worsening mitral regurgitation for which re-operation at the sixteenth month of follow-up was necessary. The third patient had no residual leak, with normal prosthetic function. At 24 months follow-up, all patients were in satisfactory clinical status. Although RT-3D TEE plays an essential role in guidance of transcatheter closure of mitral PVLs with AVP III, the absence of a specific closure device limits mid and long-term success rates.

The Current Status of Fluoroscopy and Echocardiography in the Diagnosis of Prosthetic Valve Thrombosis—A Review Article

“…CF has been also used as an effective, noninvasive, readily available diagnostic method for assessment of prosthetic heart valves, but the role of CF has declined since the introduction of TEE, which is a semi‐invasive method. Echocardiography has witnessed great improvements in technology over the past three decades; especially, real time (RT) handling of three‐dimensional (3D) information has been a milestone in the era of cardiovascular imaging of both native and prosthetic valves …”

“…Echocardiography has witnessed great improvements in technology over the past three decades; especially, real time (RT) handling of three-dimensional (3D) information has been a milestone in the era of cardiovascular imaging of both native and prosthetic valves. 8,10,[13][14][15][16] In this review, we aimed to summarize the current status of CF and echocardiography in the diagnosis of PVT.…”

Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective

“…RT-3D TEE plays an invaluable role in guiding percutaneous closure of PVLs; in preprocedure sizing of the perivalvular defect, assessment of the suitability of the defect for closure (19), selection of an appropriate device, guidance of device deployment intraprocedure, and the confirmation of defect closure postprocedure. However, the existing devices are off-label which directly contributes to procedural failure.…”

Usefulness of live/real time three/four‐dimensional transesophageal echocardiography in the percutaneous closure of an iatrogenic aorto‐right ventricular fistula

“…This may help the operator select the optimum device size and facilitate deployment because cropping can be easily and quickly performed during the procedure. This modality has been frequently used to choose the correct device to close paravalvular leaks and, overall, it appears that 3/4DTEE is superior to 2DTEE . An oversized or undersized closure device can result in failed closure procedures and complications, such as damage to the aortic wall, interference with aortic prosthesis motion or device embolization.…”