Multimodality imaging guidance for percutaneous paravalvular leak closure: Insights from the multi-centre FFPP register

Hascoët, Sébastien; Smołka, Grzegorz; Bagate, François; Guihaire, Julien; Potier, A; Hadeed, Khaled; Lavie-Badie, Yoan; Bouvaist, Hélène; Dauphin, Claire; Bauer, Fabrice; Nejjari, Mohammed; Pillière, Rémy; Brochet, Éric; Mangin, Lionel; Bonnet, Guillaume; Ciobotaru, Vlad; Leurent, Guillaume; Hammoudi, Najib; Aminian, Adel; Karsenty, Clément; Spaulding, Christian; Armero, Sébastien; Collet, F; Champagnac, Didier; Ternacle, Julien; Martin, Kathleen A.; Gérardin, Benoît; Isorni, Marc-Antoine

doi:10.1016/j.acvd.2018.05.001

Cited by 47 publications

(21 citation statements)

References 30 publications

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“…Paravalvular leak is a potentially life-threatening complication of transcatheter valve replacement. Although no large-scale prospective studies have been performed, there is growing body of case reports, suggesting decreased incidence of paravalvular leak and improved outcomes for transcatheter aortic and mitral valve replacement planned with the use of a 3D printed anatomic model [ 20 , 39 – 59 , 63 – 81 ]. Complicated surgically placed aortic and mitral valve replacements, as well as pulmonary or tricuspid valves, may also benefit from anatomic models [ 60 – 62 , 82 – 98 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions

et al. 2020

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Background Medical 3D printing as a component of care for adults with cardiovascular diseases has expanded dramatically. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for adult cardiac 3D printing indications. Methods A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of adult cardiac indications, physiologic, and pathologic processes. Each study was vetted by the authors and graded according to published guidelines. Results Evidence-based appropriateness guidelines are provided for the following areas in adult cardiac care; cardiac fundamentals, perioperative and intraoperative care, coronary disease and ischemic heart disease, complications of myocardial infarction, valve disease, cardiac arrhythmias, cardiac neoplasm, cardiac transplant and mechanical circulatory support, heart failure, preventative cardiology, cardiac and pericardial disease and cardiac trauma. Conclusions Adoption of common clinical standards regarding appropriate use, information and material management, and quality control are needed to ensure the greatest possible clinical benefit from 3D printing. This consensus guideline document, created by the members of the RSNA 3D printing Special Interest Group, will provide a reference for clinical standards of 3D printing for adult cardiac indications.

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Section: Discussionmentioning

confidence: 99%

Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions

et al. 2020

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“…2 Pre-and intra-procedural evaluation and guidance by 3D echocardiography is critical for preprocedural planning and successful closure. 3,4 The procedure is sometimes technically challenging due to the location, size and/or shape of the defect as well as the possibility of interfering with the discs of the mechanical valve. This is particularly true in very large defects where the use of more than one large device is anticipated posing both planning and technical challenges.…”

Section: Discussionmentioning

confidence: 99%

The utility of 3D printed models in complex percutaneous paravalvular leak interventions

ElGuindy

Osman

Elborae

et al. 2020

gcsp

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Paravalvular leaks (PVL) are seen in 5-17% of patients after surgical mitral and aortic valve replacement. This is usually well-tolerated in the majority of patients; however, up to 5% will require re-intervention due to either hemodynamically significant regurgitation or hemolysis requiring repeated blood transfusion. Transcatheter closure of PVLs is becoming the treatment of choice in many patients owing to the high risk of redo surgery, high rates of recurrence with the surgical approach, and substantial improvements in device technology and growing expertise in structural heart disease interventions. Careful selection of the appropriate candidates by the Heart Team with in-depth analysis of clinical and multimodality imaging data is critical to ensuring good short- and long-term outcomes.The defect is usually oval/ crescentic and often serpiginous in nature, which poses significant challenges in the optimal size and number of devices to implant - especially with large size defects. Generally, defects involving more than 25-30% of the sewing ring are generally deemed unsuitable for percutaneous closure. While the Amplatzer family of vascular plugs (e.g. AVP3 and AVP2) is commonly used for percutaneous closure of PVLs, there are currently no approved dedicated devices for this indication, except the paravalvular leak device (Occlutech) which is not universally available. Small and relatively circular defects can usually be closed using a single plug, conventionally utilizing a size that is 25-30% larger than the mean diameter of the defect. Larger and crescentic defects on the other hand frequently require more than one plug and can be quite challenging in terms of choosing the appropriate size(s).We report two cases with very large defects with irregular shape in which 3D printed modeling was extremely useful for bench testing to optimize the number and sizes of devices to be implanted.

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“…Subsequently, the gantry is positioned until the best gantry position is found where the PVL and color flow jet are identified is outside the sewing ring of the prosthetic mitral valve. This combined EFF image allows for a much more efficient process of recognizing the PVL, crossing the PVL, and subsequently aligning the delivery system and the device to close the PVL 10,18,23 . Anatomic 3D rendering meshes help define adjacent structure and chambers, defining key boundaries of the procedure.…”

Section: Structural Heart Disease Interventionsmentioning

confidence: 99%

Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance

et al. 2020

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Increased catheter-based interventions in congenital and structural heart disease require imaging modalities to be oriented in the same visual perspective. The use of echocardiography-fluoroscopy fusion (EFF) imaging has been developed for better characterization of complex anatomy and to facilitate key steps in interventional procedures. This review will detail the technology behind EFF, the differences between the two ultrasound fusion systems, and essential features of EFF imaging in congenital and structural heart disease interventions.

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Multimodality imaging guidance for percutaneous paravalvular leak closure: Insights from the multi-centre FFPP register

Cited by 47 publications

References 30 publications

Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions

Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: adult cardiac conditions

The utility of 3D printed models in complex percutaneous paravalvular leak interventions

Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance

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