Transapical repair of mitral valve paravalvular leakage using 3‐D transesophageal guidance

Abstract

We report a case where transapical access with real time 3D transesophageal echocardiographic guidance is used for repair of a mitral valve paravalvular leakage. The transapical approach is a new, elegant, and relative safe alternative for repair of a paravalvular defect in high-risk patients. The use of real time 3DTEE for guiding the procedure provides the operator fast and complete information about the leakage, and allowing online monitoring of the procedure.

Transapical treatment of paravalvular leaks in patients with a logistic euroscore of more than 15%

“…With our few experience, a transapical approach might be easier and less time‐consuming compared to the transfemoral approach, resulting in a high rate of procedural success and a shorter procedural length. Increasing experience with transapical interventions and assistance of modern imaging techniques, gives opportunities to explore other interventions in the systemic ventricle with this alternative approach [20].…”

Three-dimensional Echocardiography

“…The value of RT3D TEE during percutaneous implantation of one or multiple occluder devices to paravalvular leaks of the aortic or mitral valve has been demonstrated by several investigators (. More recently, as an alternative to antegrade transseptal access, a transapical or a retrograde transaortic approach to paravalvular leaks has been described where RT3D TEE was also demonstrated to be indispensable f or guiding and monitoring the procedure [95][ [96] [97]. 12 [94].…”

Repair of perivalvular leakage without re-replacement of prosthetic valves☆

“…However, there is a possibility of new PVL developing in another part of the valve, if valve re-replacement is performed. Recently, percutaneous or trans-apical repair for PVL has been reported [4,5]. However, its performance should be limited to critically ill patients.…”