Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI.

Stenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease.

TPVLC with simultaneous deployment of multiple AVP III occluders is feasible with high device success rate and no significant periprocedural complications. The clinical benefits of reduction of HF symptoms and hemolysis are evident after 30 days and persist up to 1 year without recurrence of PVL.

A 67-year-old woman, with a history of inferior wall myocardial infarction, presented at a general hospital with a 4-week history of sudden onset heart failure in New York Heart Association functional class III. Echocardiography revealed inferior wall pseudoaneurysm formation, probably because of recent myocardial infarction (Fig. 1A). Because the patient refused the proposal of immediate surgical treatment, we planned a percutaneous procedure. Coronary angiography revealed occlusion of the peripheral segment of the right coronary artery, multilevel critical stenoses in the left anteFigure 1. Inferior Wall Pseudoaneurysm Formation (A) Echocardiography (apical 2-chamber view): inferior wall pseudoaneurysm cavity. (B) Left ventriculography view: rupture in the left ventricular inferior wall and opacification of pseudoaneurysm cavity. (C) Multislice computed tomography reconstruction: for optimal visualization of pseudoaneurysm cavity, the right ventricle was removed. (D) Left ventricle and pseudoaneurysm cavity-largest dimension cross-section: noticeably thinned myocardium within post-infarction necrotic tissue in the region of inferior wall and myocardial discontinuity visible. Posteromedial papillary muscle is localized superior to the pseudoaneurysm orifice. *Pseudoaneurysm cavity.

Background: Paravalvular leaks can be detected in almost 15% of patients after mitral valve prosthesis implantation. This complication can result in congestive heart failure and hemolysis. Despite advancements in non-invasive imaging, percutaneous closure of paravalvular leaks is not always successful. Therefore, efforts are made to improve treatment outcomes by using 3D-printed models of defects as pre-procedural support for interventional cardiologists. Methods: Retrospectively, 3D-transesophageal echocardiography recordings of 8 patients with clinically significant mitral paravalvular leaks were analyzed. Qlab Software was used to export DICOM images of each paravalvular leak channel, including surrounding tissue. Image segmentation was performed in 3D Slicer, a free, open-source software package used for imaging research. Models were printed to actual size with the poly jet Stratasys Objet 30 printer with a transparent, rigid material. Results: Duration of model preparation and printing, as well as the total cost, was calculated. Mean total time of model preparation was 430.5 ± 196 minutes. Conclusion: 3D-printing from 3D-transesophageal echocardiography is technically feasible. Both shape and location of paravalvular leaks are preserved during model preparation and printing. It remains to be tested if 3D-printing would improve outcomes of percutaneous paravalvular leaks closure.