Correção de regurgitação paravalvar mitral por via percutânea guiada por ecocardiograma transesofágico tridimensional

Correction of extensive mitral paravalvular leak with three occlusion devices via transapical access: a case report

“…Therefore, transcatheter closure becomes a safer alternative for this group, especially those who have undergone two or more previous surgeries, considering that reoperation in these patients is associated with a 16% mortality rate. 6 Transcatheter closure can promote a significant reduction in the paravalvular regurgitation, promoting an improvement in FC and better quality of life. 7 Confirming the safety of this procedure, a recent study demonstrated short-term adverse events, such as stroke, kidney failure with progression to dialysis, pneumonia, prolonged ventilation, hemothorax and cardiac tamponade, occurred significantly more frequently in patients undergoing surgical repair, when compared to those submitted to transcatheter closure (22.5% versus 7.7%; p<0.001).…”

“…1,8 Based on this, Millán et al, in a study comparing surgical and transcatheter methods, showed that, despite its higher perioperative morbidity and mortality, surgery still leads to the best outcomes in the long follow-up. 8 Although the transfemoral approach is the most discussed access route in the literature, 6 it can become a real technical challenge, especially in more medial and larger leaks, due to excess of curvatures and angulations along the path between the femoral vein and the PVL. 9 The transapical access, on the other hand, offers short and direct access to the PVL, with easier control of catheters and devices, and more precise handling of the material -an important factor when planning the implantation of multiple occlusive prostheses.…”

“…9 Success in PVL treatment depends on a collaborative work by the echocardiographer and the interventionist to precisely determine the dimensions of the PVL and to locate its regurgitation site. 2,6 The aid of three-dimensional TEE allows a better evaluation of the characteristics of the cardiac defect and the actions during the procedure. 2 This technique was of paramount importance in the present report, since it helped positioning the three occlusive devices and adjusting them to the PVL shape.…”

“…7 This structural diversity, besides increasing the technical complexity of the procedure, renders a complete PVL occlu sion difficult to be achieved. 2,6 For this reason, the development of new devices with multiple shapes and sizes is needed to improve the results of this intervention. 4,5 In patients with mitral valve prosthesis who develop PVL and are at high surgical risk, a transapical transcatheter correction is an alternative therapy that can be successfully performed, with significant clinical improvement for the patient.…”