Page 15 - Journal of Structural Heart Disease - Volume 1 Issue 1

Original Research Article
Journal of Structural Heart Disease, May 2015, Volume 1, Issue 1: 9-19
DOI: http://dx.doi.org/10.12945/j.jshd.2015.00011-14
Received: December 8, 2014 Accepted: December 15, 2014 Published online: May 2015
Real-Time 3D Transesophageal Echocardiographic Guidance of Prosthetic Valve Paravalvular Leak
Joseph M. Venturini MD, Anuj Mediratta MD, Karima Addetia MD, Sandeep Nathan MD, Atman P. Shah MD, Roberto M. Lang MD*
University of Chicago Medical Center, Section of Cardiology, Chicago, Illinois, USA
The first two authors contributed equally to the manuscript.
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Abstract
Paravalvular leak (PVL), defined as retrograde blood flow adjacent to an annuloplasty ring (Figure 1 a, Video 1) or prosthetic valve (Figure 1 b, Video 2), is a rare but serious complication of heart valve surgery. Though most PVLs are asymptomatic, 1–5% of pa- tients develop serious clinical consequences such as heart failure, endocarditis, or hemolysis [1,2]. Sur- gical repair may be necessary in severe cases, how- ever for those who are at high surgical risk, a per- cutaneous approach can be performed to occlude these defects [1,3-9]. Real-time three-dimensional
transesophogeal echocardiography (3DTEE) during percutaneous closure procedures is invaluable for in- tra-procedural guidance. In this article, we will review the literature and outline two cases where real-time 3DTEE guidance was critical for successful closure of symptomatic PVL.
Copyright © 2015 Science International Corp.
Key Word
3D TEE Guidance
Cases
Case 1
A 64-year-old female with history of congenital heart disease requiring ostium primum atrial septal defect (ASD) repair and multiple mitral valve replacements presented with worsening heart failure. Most recently, she underwent a third mechanical mitral valve replacement (in the setting of severe PVL), mechanical aortic valve replacement, tricuspid valve repair, and ventricular septal defect repair. Since her last surgery, she developed New York Heart
* Corresponding Author:
Roberto M. Lang, MD, FASE
Section of Cardiology
University of Chicago Medical Center
5841 South Maryland Avenue, M512, Chicago, Illinois 60637, USA
Tel.: +1 773 702-1842, Fax: +1 773 702-1034, E-Mail: rlang@medicine.bsd.uchicago.edu
Video 1.
Annuloplasty ring dehiscence.
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2015 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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