Paravalvular leak closure with real time transesophageal echocardiography and fluoroscopy fusion

Abstract

Transcatheter technology has been increasingly used for paravalvular leak closure. We report the use of “ Fusion Technology” (EchoNaviagator, Phillips, Tustin, CA) that combines real-time 2 and 3 dimensional trans-esophageal echocardiography with fluoroscopy imaging to facilitate paravalvular leak closure. This could help to identify the exact site, size, depth and shape of the paravalvular leak for proper positioning of the occluder device, which may result in saving time and effort.

Transesophageal Echocardiography (TEE)-Guided Paravalvular Leak (PVL) Closure: Expanding Horizons Beyond Operating Room

“…Recently, Ahmed et al have named this technology as "Fusion Technique," where they have combined real-time 2D and 3D TEE with fluoroscopy to facilitate closure of PVL. 14 Now that the time of minimally invasive surgery has taken over conventional surgery and fast tracking and enhanced recovery after surgery (ERAS) is the need of the moment, percutaneous PVL closure is preferred over surgical PVL closure. A study done by Gakrinho et al showed that percutaneous PVL closure has a reasonable success rate along with a low complication rate and the results are comparable to surgical treatment in high-risk patients.…”

Como Eu Faço Abordagem para Avaliação de Leak Paraprotético Mitral

“…Em casos de sombras acústicas devido a próteses que apresentam uma limitação significativa ao ETE, o uso do software EchoNavigator, já empregado em procedimentos transcateter de outras valvopatias, pode ser uma ferramenta útil para orientar a equipe intervencionista. 16 A produção de modelos impressos em 3D para o adequado planejamento da intervenção e, também, para treinamento em centros formadores tem emergido como técnica interessante. O primeiro passo é adquirir os dados da imagem em alta qualidade em um formato DICOM (Digital Imaging and Communication in Medicine), seja pela ecocardiografia, tomografia ou outro método.…”

Advances in TEE-Centric Intraprocedural Multimodal Image Guidance for Congenital and Structural Heart Disease

“…Real-time CT-fluoroscopy fusion has been attempted in PVL closures, especially in apical surgery [ 105 ]. More recently, EchoNavigator was used to assist interventionalists for treating PVL [ 106 , 107 ]. Ahmed et al particularly noted that EchoNavigator helped identify the exact site, size, depth, and shape of the PVL, and it subsequently facilitated navigating a guidewire across the leak [ 107 ].…”

“…More recently, EchoNavigator was used to assist interventionalists for treating PVL [ 106 , 107 ]. Ahmed et al particularly noted that EchoNavigator helped identify the exact site, size, depth, and shape of the PVL, and it subsequently facilitated navigating a guidewire across the leak [ 107 ]. TEE imaging can be useful in PVL cases, as shown in Figure 15 ; however, imaging may be further limited because the presence of the prosthetic valves creates acoustic artifacts (i.e., acoustic shadowing and reverberations).…”

“…This innovation holds the potential to accurately pinpoint the precise location, dimensions, depth, and morphology of the paravalvular leak, thus aiding in the accurate placement of the occluder device. [ 107 ] 2020 TEE This article showed how TEE adds value in intraoperative settings in open, minimally invasive, or hybrid cardiac surgery procedures. [ 110 ] 2021 MR, nuclear imaging, and ultrasound This study discussed the use of cardiac magnetic resonance imaging to visualize the structure and function of the heart, as well as the issue of precise tissue characterization through a range of sequences, thereby offering [ 9 ] distinct perspectives on factors like fibrosis, infiltration, inflammation, edema, fat presence, strain, and other possible pathological attributes that can impact upcoming cardiovascular risks.…”