Abstract
The presence of clinically significant paravalvular leak (PVL) that warrant repair ranges from 1 to 5% of patients with prosthetic valves and it is usually related to tissue friability, annular calcification, valve infection or technical factors. Surgical repair is the standard treatment for symptomatic PVL. Because of the increased risk of reoperation, there is tremendous interest in percutaneous closure of PVL. The accurate determination of the anatomical characteristics of the PVL (i.e. site, size and shape) is of paramount importance for proper selection of patients suitable for percutaneous closure, and the key for success of the procedure. 3D TEE appears to be the ideal technique for this purpose. In this chapter we will describe the normal 3D TEE appearance of mitral valve prostheses (both mechanical and biological), the 3D TEE imaging of mitral and aortic PVL, and, finally, the current role of 3D TEE during percutaneous PVL closure.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsSuggested Reading
Cortes M, Garcia E, Garcia-Fernandez MA, Gomez JJ, Perez-David E, Fernandez-Aviles F. Usefulness of transesophageal echocardiography in percutaneous transcatheter repairs of paravalvular mitral regurgitation. Am J Cardiol. 2008;101:382–6.
Garcia-Borbolla Fernandez R, Sancho Jaldon M, Calle Perez G, Gomez Menchero AE, de Zavas RR, Arana Granado R, et al. Percutaneous treatment of mitral valve periprosthetic leakage. An alternative to high-risk surgery? Rev Esp Cardiol. 2009;62:438–41.
Garcıa-Fernandez MA, Cortés M, Garcıa-Robles JA, Gomez de Diego JJ, Perez-David E, Garcia E. Utility of real-time three dimensional transesophageal echocardiography in evaluating the success of percutaneous transcatheter closure of mitral paravalvular leaks. J Am Soc Echocardiogr. 2010;23:26–32.
Genoni M, Franzen D, Tavakoli R, Seiffert B, Graves K, Jenni R, Turina M. Does the morphology of mitral paravalvular leaks influence symptoms and hemolysis? J Heart Valve Dis. 2001;10:426–30.
Hammerstingl C, Lickfett L, Nickening G. Real-time three-dimensional transoesophageal echocardiography for guidance of interventional closure of paravalvular leakage. Eur Heart J. 2009;30:915.
Hourihan M, Perry SB, Mandell VS, Keane JF, Rome JJ, Bittl JA, Lock JE. Transcatheter umbrella closure of valvular and paravalvular leaks. J Am Coll Cardiol. 1992;20:1371–7.
Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvular regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003;89:1316–21.
Jindani A, Neville EM, Venn G, Williams BT. Paraprosthetic leak: a complication of cardiac valve replacement. J Cardiovasc Surg (Torino). 1991;32:503–8.
Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, Garcia Fernandez MA, Lang RM. Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. J Am Coll Cardiol. 2009;53:1543–7.
Pate GE, Thompson CR, Munt BI, Webb JG. Techniques for percutaneous closure of prosthetic paravalvular leaks. Catheter Cardiovasc Interv. 2006;67:158–66.
Ruiz CE, Jelnin V, Kronzon I, Dudly Y, Del Valle-Fernandez R, Einhorn BN, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol. 2011;58:2210–7.
Shapira Y, Hirsch R, Kornowski R, Hasdai D, Assali A, Vaturi M, et al. Percutaneous closure of perivalvular leaks with Amplatzer occluders: feasibility, safety, and short-term results. J Heart Valve Dis. 2007;16:305–13.
Author information
Authors and Affiliations
8.1 Electronic Supplementary Material
Below is the link to the electronic supplementary material.
309054_1_En_8_MOESM1_ESM.avi
Mechanic mitral valve prosthesis in “en face” perspective (AVI 2309 kb)
309054_1_En_8_MOESM2_ESM.avi
Mechanic mitral valve prosthesis in an “oblique” perspective (AVI 2227 kb)
Surgical view of a mitral valve prosthesis enabling the location of a PVL from 3 to 6 o’ clock (on a virtual clock with the aortic valve located at 12 and the LAA at 9 o’clock) (AVI 942 kb)
Aortic valve prosthesis: perspective from the aorta detecting site, size, and shape of the PVL (AVI 1430 kb)
Percutaneous closure of a mitral ring PVL: anterograde approach—expansion of the atrial disc, observed from a left atrial view (AVI 15228 kb)
Video 8.1
Mechanic mitral valve prosthesis in “en face” perspective (AVI 2309 kb)
Video 8.2
Mechanic mitral valve prosthesis in an “oblique” perspective (AVI 2227 kb)
Rights and permissions
Copyright information
© 2014 Springer-Verlag London
About this chapter
Cite this chapter
Faletra, F.F., Perk, G., Pandian, N.G., Nesser, HJ., Kronzon, I. (2014). Percutaneous Closure of Paravalvular Leaks. In: Real-Time 3D Interventional Echocardiography. Springer, London. https://doi.org/10.1007/978-1-4471-4745-9_8
Download citation
DOI: https://doi.org/10.1007/978-1-4471-4745-9_8
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-4744-2
Online ISBN: 978-1-4471-4745-9
eBook Packages: MedicineMedicine (R0)