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. 2022 Jun 1;11(11):3155.
doi: 10.3390/jcm11113155.

Paravalvular Leak Echo Imaging before and during the Percutaneous Procedure

Piotr Pysz  1 , Wojtek Wojakowski  1 , Grzegorz Smolka  1
Affiliations

Paravalvular Leak Echo Imaging before and during the Percutaneous Procedure

Piotr Pysz et al. J Clin Med. .

Abstract

Percutaneous device closure has become a valuable alternative to surgery in the management of paravalvular leaks. Consequently, imaging in these patients is currently not only meant to verify the hemodynamic significance of the lesion but also to assess the feasibility of transcatheter treatment. We present a methodology of comprehensive echocardiography assessment that allows for the selection of patients and plans the intervention. Next, procedure-oriented steps of echocardiography imaging, which are essential for eventual success, are reviewed.

Keywords: device closure; echocardiography; paravalvular leak.

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Conflict of interest statement

P.P. and G.S. are consultants and proctors for Occlutech and Abbott, manufacturers of the devices mentioned in the manuscript; W.W. declares no conflict of interest.

Figures

Figure 1
Figure 1
(A) RT-3D TOE multi-planar visualization of PVL’s vena contracta—measurement of its area (left lower panel). (B) RT-3D TOE multi-planar visualization of PVL’s vena contracta—measurement of its length (left upper panel) along with minimal and maximal extent (left lower panel).
Figure 2
Figure 2
Advanced 3D image rendering with artificial “source of light” placed in the LV cavity allowing the precise visualization of the septa (arrows) dividing the PVL lumen (MVpr—mitral bioprosthesis, IAS—interatrial septum).
Figure 3
Figure 3
Biplanar imaging of the interatrial septum tenting produced by the tip of the transseptal sheath.
Figure 4
Figure 4
3D TOE volume rendering visualization of the interatrial septum tenting (black arrow) produced by the tip of transseptal sheath (IVC: inferior vena cava; Ao: aortic root).
Figure 5
Figure 5
(A) Biplanar imaging of the tip of the catheter at the sewing ring of prosthetic valve. (B) Biplanar color doppler marking of the PVL’s narrow orifice enabling precise catheter maneuvering.
Figure 6
Figure 6
TOE long-axis view of the aortic bioprosthesis poorly visible on X-ray—distal disc of the occluder visualized while being implanted in the PVL located at the right coronary sinus.
Figure 7
Figure 7
(A) Mitral PVL closure, TOE biplanar imaging allowing for simultaneous controlling of the plug implantation (left panel) and preserved prosthetic discs opening (right panel—diastole, discs symmetrically opened). (B) Mitral PVL closure, TOE biplanar imaging allowing for simultaneous controlling of the plug implantation (left panel) and preserved prosthetic discs closing (right panel—systole, discs symmetrically closed).
Figure 7
Figure 7
(A) Mitral PVL closure, TOE biplanar imaging allowing for simultaneous controlling of the plug implantation (left panel) and preserved prosthetic discs opening (right panel—diastole, discs symmetrically opened). (B) Mitral PVL closure, TOE biplanar imaging allowing for simultaneous controlling of the plug implantation (left panel) and preserved prosthetic discs closing (right panel—systole, discs symmetrically closed).
See this image and copyright information in PMC

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