Utility of Three‐Dimensional Echocardiography in Percutaneous Closure of Paravalvular Leak

Bavikati, Venkata V.; Babaliaros, Vasilis

doi:10.1111/j.1540-8175.2008.00840.x

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…In mitral prosthetic valve dehiscence, it is known to be superior over 2D TEE 7 in that it provides additional information about the complex 3D anatomy, spatial orientation and size of the dehiscence, helps in planning the corrective procedure 8 and in facilitating procedural success. 9 As an alternative or integrative method, ICE has emerged as an effective option to improve detail definition and guide percutaneous interventional procedures 10 …”

Section: Discussionmentioning

confidence: 99%

The Challenge of Integrated Echocardiographic Approach in Percutaneous Closure of Paravalvular Leak

et al. 2011

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Paravalvular leak after prosthetic mitral valve surgery may lead to symptomatic mitral regurgitation and hemolytic anemia requiring reoperation. Percutaneous closure of paravalvular leaks is a relatively recent technique still considered a challenging procedure burdened by possible complications, to be offered only to poor redo surgical candidate patients. Multimodality imaging is advocated to plan and guide the procedure, to minimize the risk of complications. We report on a case of dehisced prosthetic mitral valve in which transthoracic real time three-dimensional echocardiography was used to locate the dehiscence area and characterize mitral paraprosthesis leak, whereas intracardiac echocardiography was used to guide and monitor the percutaneous closure procedure.

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Section: Discussionmentioning

confidence: 99%

The Challenge of Integrated Echocardiographic Approach in Percutaneous Closure of Paravalvular Leak

et al. 2011

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“…RT‐3DE is an ideal tool for offering visual feedback during the procedure, especially with percutaneous interventions like valvuloplasty or minimally invasive aortic valve replacements. This guidance provided by 3DE will help to reduce procedure time and will improve the efficiency, quality, and safety of the procedures 81 …”

Section: Future Directionsmentioning

confidence: 99%

Three‐Dimensional Echocardiography in Valvular Heart Disease

Cai

Ahmad

2012

Echocardiography

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Two-dimensional echocardiography (2DE) with color Doppler has been the standard tool for assessing valvular heart disease. However, this requires conceptualizing three-dimensional (3D) valvular anatomy from individual 2D slices, which is inadequate for complex valvular abnormalities. Similarly, Doppler-based methods are inherently limited by several assumptions and are influenced by hemodynamics and concomitant valvular disease. 3DE has improved both morphological and functional assessment of valvular heart disease. It provides additional morphological information, which leads to better understanding of the mechanism of valvular dysfunction and surgical planning. 3D planimetry has proven to be accurate in the evaluation of valvular stenosis. This direct assessment eliminates measurement errors and could potentially serve as new gold standard. The continuity equation for aortic stenosis can be simplified by directly measuring left ventricular outflow tract area and stroke volume. In patients with valvular regurgitation, vena contracta area can be directly measured by using 3D color Doppler which is more accurate than the standard 2D methods. By applying hemi-elliptical formula or directly measuring isovelocity surface area, 3DE has significantly improved the accuracy in regurgitant severity assessment. This is particularly useful in patients with eccentric jets. 3DE has an advantage over 2DE in assessment of tricuspid valve due to its complex geometry. Direct planimetry of orifice area in tricuspid stenosis, or vena contracta area in tricuspid regurgitation are promising although validation studies are needed before they can be applied for clinical decision making. 3DE has not been widely studied in pulmonic valve disease but preliminary data indicate that it is feasible.

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“…So, RT-3D TEE is superior over 2D TEE in assessment of mitral prosthetic valve dehiscence (16). It provides additional information about the complex 3D anatomy, spatial orientation and size of the dehiscence, helps in planning the corrective procedure (8) and in facilitating procedural success (17,18).…”

Section: Discussionmentioning

confidence: 99%

Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective

Gürsoy

Astarcıoğlu²,

Gökdeniz³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Paravalvular leaks (PVLs) commonly occur in mitral prostheses. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) may provide invaluable information about complex 3D anatomy of mitral PVLs compared to two-dimensional (2D) TEE findings. We, herein, aimed to evaluate the detailed description of anatomical characteristics of severe mitral PVLs using RT-3D TEE. Methods: Patients with diagnosis of severe mitral PVLs were simultaneously examined with 2D transthoracic echocardiography (TTE), 2D TEE, and RT-3D TEE. 3D characteristics of PVLs (localization, number, size, shape, etc.) were recorded and compared to 2D findings. Results were also compared with surgical findings. Results: The study comprised 47 cases (3 bioprosthesis, 44 mechanical) with 61 severe mitral PVLs. The most common PVL localizations were anterolateral commissure, posteromedial commissures and posterolateral region. The mean PVL width measured by 2D TEE was 3.1±1.3 (range; 2-7) mm and the mean width of defect measured by 3D TEE was 3.1±1.1 (range; 2-7) mm (p=0.7). The mean length of defect measured by 3D TEE was 11.1±6.5 mm. The most common defect type was 'oval/round' shaped (n=29; 48%). There were also 19 'crescentic' (31%), 9 'slit like' (15%), and 2 tunnel-like shaped defects. In 22 patients, the site and dimension of the PVLs were all confirmed surgically. Conclusion: RT-3D TEE permits detailed structural evaluation of the prosthesis and description of paravalvular leak morphology compared to 2D TEE. It may provide more accurate information to the clinician in decision making and may contribute to the success of the potential corrective procedures. (Anadolu Kardiyol Derg 2013; 13: 633-40) Key words: Paravalvular mitral regurgitation, real-time three-dimensional transözofageal echocardiography Original Investigation Özgün Araşt›rma 633ÖZET Amaç: Paravalvüler kaçaklar (PVK) genellikle mitral protez kapaklarda görülür. Gerçek zamanlı üç-boyutlu transözofageal ekokardiyografi (GZ-3B TÖE) iki boyutlu transözofageal ekokardiyografi (2B TÖE) ile kıyaslandığında mitral protez kapağın kompleks 3B anatomisi hakkında paha biçilmez bilgiler sunar. Bu çalışmada GZ-3B TÖE'yi kullanarak ileri mitral PVK'ların detaylı anatomik özelliklerini incelemeyi hedefledik.Yöntemler: İleri PVK'sı olan hastalar eş zamanlı 2B transtorasik ekokardiyografi, 2B TÖE ve GZ-3B TÖE ile incelendi. PVK'ların 3B özellikleri (yerleşimi, boyutları, şekilleri, sayıları vs.) kaydedildi ve 2B görüntülerle kıyaslandı. Sonuçlar cerrahi bulgularla da kıyaslandı. Bulgular: Çalışma 47 mitral protez kapak hastasını (3 biyoprotez, 44 mekanik) ve toplam 61 PVK'yı kapsıyordu. En sık PVK yerleşimi anterolateral komissür, posteromediyal komissür ve posterolateral bölge idi. 2B TÖE ve 3B ile ölçülen ortalama defekt eni sırasıyla 3,1±1,3 (aralık; 2-7) mm ve 3,1±1,1 (aralık; 2-7) mm idi (p=0,7). 3B TÖE ile ölçülen defekt uzunluğu ise 11,1±6,5 mm idi. En sık defekt türü 'oval/yuvarlak' (n=29; %48) idi. Ayrıca 19 hilal şekilli (%31), 9 kesik şekilli (%15) ve 2 tünel...

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Utility of Three‐Dimensional Echocardiography in Percutaneous Closure of Paravalvular Leak

Cited by 10 publications

References 5 publications

The Challenge of Integrated Echocardiographic Approach in Percutaneous Closure of Paravalvular Leak

The Challenge of Integrated Echocardiographic Approach in Percutaneous Closure of Paravalvular Leak

Three‐Dimensional Echocardiography in Valvular Heart Disease

Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective

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