Utility of Real-Time Three-Dimensional Transesophageal Echocardiography in Evaluating the Success of Percutaneous Transcatheter Closure of Mitral Paravalvular Leaks

Abstract

The percutaneous closure of mitral paravalvular leaks has been reported in patients who are poor operative candidates. Unsuccessful percutaneous closure of leaks may be related to morphologic characteristics of the defects. Ten patients were selected from a database for mitral dehiscence closure, in whom two-dimensional transesophageal echocardiography revealed inadequate leak closure. Another 4 patients with optimal results were also selected. Real-time three-dimensional transesophageal echocardiography (3DTEE) was performed in all of them. Real-time 3DTEE enabled the determination of the locations and number of the leaks, as well as their shapes, lengths, widths, areas, and extent. We were also able to observe the position of the device (or devices) implanted during percutaneous closure. According to this preliminary study, 3DTEE can improve understanding of the causes underlying failure of these techniques to reduce regurgitation secondary to a defect. This could improve patient selection and procedure results, but further studies are needed.