Echo Guiding During Transcatheter Paravalvular Leak Closure
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Transcatheter paravalvular leak closure (TPVLC) is one of the most echo-dependent cardiac structural interventions. During procedures performed under general anesthesia (GE), implementation of transesophageal echocardiography (TEE) is obviously preferable. Nevertheless, the intention to use TEE should not be the only factor motivating the use of GE as TEE probe is usually well tolerated throughout the procedure provided adequate conscious sedation (e.g., intravenous benzodiazepine + fentanyl). Intracardiac echocardiography (ICE) may be considered an alternative to TEE in non-intubated patients but only to a limited extent . With the catheter placed in the right atrium (RA), it is useful for monitoring transseptal puncture, but its so far mainly two-dimensional (2D) nature with only limited three-dimensional (3D) possibilities renders it inferior to real-time (RT) 3D TEE when it comes to navigating within the left atrium (LA).
CD-mapped flow across PVL with identification of true VC (arrow) (MP4 139 kb)
Direction of guidewire extension visualized by zoomed RT 3D TEE VR (also visible previously implanted plugs in adjacent location) (AVI 27653 kb)