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Archives of cardiovascular diseases
Volume 106, n° 4
pages 244-245 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.003
Interest of 3D TEE for the percutaneous closure of paraprosthetic mitral valves leaks
 

O. Belliard, B. Gerardin, S. Janower, A. N Guyen, M. Terdjman, R. Pilliere, J.-C. Dib
 CMC Ambroise-Paré, Neuilly-Sur-Seine, France 

Prosthetic valve leaks are rare, mainly mitral, and difficult to treat due to possible refractory heart failure and anemia. In case a new surgical operation is too risky, percutaneaous closure has been proposed.

The main difficulty of this procedure is the passage of the guide wire through the regurgitant orifice. 2D angiography alone cannot locate and guide the procedure with enough precision. A 3D anatomical imaging obtained real time using 3D TEE minimizes this difficulty. We have also observed that the anatomy of the regurgitation zone, as well as its location, can be very different from one patient to another.

We report 11 consecutive closures of mitral paravalvular leaks between 2009 and 2012, in seven patients (four men, range 1 to 4 procedures per patient). Mean age was 71 y. and 5/7 patients (71%) had mechanical prosthesis.

The procedural closure success rate was 64% (7/11) with a mitral regurgitation regression of at least one grade. The clinical impact was rapidly evident with a reduction of the NHYA grade (from 1 to 2) and reduction in the need of transfusion. There was no per procedure mortality.

Our experience highlights the role of 3D TEE for the location of the leak, its shape length and width in pre procedure. During the procedure it is more helpful than fluoroscopy for positioning the device.

According to this experience, percutaneous closure guided by 3D TEE can be a real alternative to surgery in symptomatic patients with high surgical risk.





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