Echo Guiding During Transcatheter Paravalvular Leak Closure

  • Piotr PyszEmail author


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 [1]. 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).

Supplementary material (3.6 mb)
Movie 5.1 Examples of PVLs with absent (ac) or present (df) surgical sutures crossing the lumen (as confirmed with catheter movements after PVL crossing). Note the differences in prosthetic ring mobility despite similar size and appearance of both lesions (ZIP 3636 kb)
Movie 5.2

CD-mapped flow across PVL with identification of true VC (arrow) (MP4 139 kb)

Movie 5.3

Direction of guidewire extension visualized by zoomed RT 3D TEE VR (also visible previously implanted plugs in adjacent location) (AVI 27653 kb) (565 kb)
Movie 5.4 Onset of SEC promptly following mitral TPVLC (a, before TPVLC; b, after TPVLC) (ZIP 565 kb) (1.1 mb)
Movie 5.5 Stentless aortic prosthesis—instant clotting of “dead space” as a result of TPVLC (a, before TPVLC; b, after TPVLC) (ZIP 1075 kb)


  1. 1.
    Krishnaswamy A, Kapadia SR, Tuzcu EM. Percutaneous paravalvular leak closure—imaging, techniques and outcomes. Circ J. 2013;77(1):19–27.CrossRefPubMedGoogle Scholar
  2. 2.
    Biner S, Kar S, Siegel RJ, et al. Value of color Doppler three-dimensional transesophageal echocardiography in the percutaneous closure of mitral prosthesis paravalvular leak. Am J Cardiol. 2010;105(7):984–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Balzer J, Zeus T, Hellhammer K, et al. Initial clinical experience using the EchoNavigator(®)-system during structural heart disease interventions. World J Cardiol. 2015;7(9):562–70.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Biaggi P, Fernandez-Golfín C, Hahn R, et al. Hybrid imaging during transcatheter structural heart interventions. Curr Cardiovasc Imaging Rep. 2015;8(9):33.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Smolka G, Pysz P, Jasiński M, et al. Multiplug paravalvular leak closure using Amplatzer Vascular Plugs III: a prospective registry. Catheter Cardiovasc Interv. 2016;87(3):478–87.CrossRefPubMedGoogle Scholar
  6. 6.
    Smolka G, Pysz P, Kozłowski M, et al. Transcatheter closure of paravalvular leaks using a paravalvular leak device—a prospective Polish registry. Postepy Kardiol Interwencyjnej. 2016;12(2):128–34.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Jelnin V, Dudiy Y, Einhorn BN, et al. Clinical experience with percutaneous left ventricular transapical access for interventions in structural heart defects a safe access and secure exit. JACC Cardiovasc Interv. 2011;4(8):868–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2017

Authors and Affiliations

  1. 1.Department of CardiologyMedical University of SilesiaKatowicePoland

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