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Case Reports
. 2022 Dec 1:5:101690.
doi: 10.1016/j.jaccas.2022.101690. eCollection 2023 Jan 4.

Computed Tomography/Fluoroscopy Fusion and 3D Transesophageal Echocardiography-Guided Percutaneous Paravalvular Leak Closure

Sandra Zendjebil  1 , Livio d'Angelo  1 , Fabien Doguet  1 , Nicolas Dumont  2 , Hakim Benamer  1 , Dominique Fourchy  1 , Morad Djebbar  1 , Jérome Garot  1 , Régis Vaillant  3 , Philippe Garot  1
Affiliations
Case Reports

Computed Tomography/Fluoroscopy Fusion and 3D Transesophageal Echocardiography-Guided Percutaneous Paravalvular Leak Closure

Sandra Zendjebil et al. JACC Case Rep. .

Abstract

Percutaneous paravalvular leak closure seems a safe alternative to surgery in frail patients. However, it is a challenging procedure that should be tailored to each patient with optimal imaging guidance. Transesophageal echocardiography during the procedure and computed tomography scan/fluoroscopy fusion provide guidance for critical steps, such as PVL localization and crossing. (Level of Difficulty: Advanced.).

Keywords: CT; CT, computed tomography; PVL; PVL, paravalvular leak; TEE; TOE, transesophageal echocardiography; closure; fusion; percutaneous.

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Conflict of interest statement

This research received no specific grant from any funding agency. Dr Zendjebil has received a research grant from Fédération Française de Cardiologie outside of this work. Mr Dumont is an employee of Abbott Vascular. Mr Vaillant is an employee of General Electric Health Care. Dr Garot is the medical director and a shareholder of CERC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Preprocedural X Plane Transesophageal Echocardiography Severe anterior and lateral mitral paravalvular leak (diameter 6.3 × 5.4 mm)
Figure 2
Figure 2
Preprocedural 3D Transesophageal Echocardiography Severe anterior and lateral mitral paravalvular leak with higher dimensions after 3-dimensional (3D) transesophageal echocardiography assessment (diameter 6 × 11 mm). 2D = 2-dimensional.
Figure 3
Figure 3
Preprocedural Computed Tomography Scan Severe anterior and lateral mitral paravalvular leak.
Figure 4
Figure 4
Procedural Computed Tomography Scan/Fluoroscopy Fusion The plug is positioned inside the paravalvular leak orifice with computed tomography scan/fluoroscopy fusion (paravalvular leak orifice is represented in green; yellow circle represents the fossa ovalis).
Figure 5
Figure 5
Plug Device Used in Both Procedures
Figure 6
Figure 6
Final 3D Transesophageal Echocardiography Correct occlusion of the paravalvular leak with the plug. 2D = 2-dimensional; 3D = 3-dimensional.
Figure 7
Figure 7
Final X Plane Transesophageal Echocardiography Correct occlusion of the paravalvular leak with the plug.
Figure 8
Figure 8
Preprocedural Transesophageal Echocardiography Severe anterior paravalvular leak around the aortic biological prosthesis.
Figure 9
Figure 9
Preprocedural Computed Tomography Scan Anterior 5-mm-wide paravalvular leak around the aortic biological prosthesis.
Figure 10
Figure 10
Prosthesis Mesh Crossing Demonstration Selection of the right prosthesis mesh to cross with the delivery sheath to access the paravalvular leak around the biological prosthesis.
Figure 11
Figure 11
Procedural Computed Tomography Scan/Fluoroscopy Fusion Paravalvular leak orifice (green line) and the targeted mesh (blue line) to cross to align the delivery sheath with the paravalvular leak. The left main mark (pink line) is useful to avoid conflict with the left main.
Figure 12
Figure 12
Final Transesophageal Echocardiography Reduction of the aortic paravalvular leak.
Figure 13
Figure 13
Preprocedural and Final Cardiac Magnetic Resonance Measured Paravalvular Leak Aortic Flow Reduction of the aortic paravalvular leak with a reduction of the regurgitated fraction (RF) from 41% to 8%.
See this image and copyright information in PMC

References

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