Paravalvular mitral leak closure under Eco-X-ray fusion guidance

Abstract

A 81-year-old female was admitted for worsening shortness of breath and lower extremity swelling. The patient had a history of mitral regurgitation and subsequent valve replacement using a mechanical prosthesis 2 years ago. Subsequent investigation revealed the presence of a severe paravalvular mitral leak (PML) around the anterolateral aspect of the sewing ring. Due to the high surgical risk PML closure was performed by percutaneous retrograde approach guided by the new 3D echo-X-ray navigation system (Echonavigator; Philips Medical Systems, Andover, MA, USA). This innovative technology allows real-time fusion of echocardiography and fluoroscopy images, even with movement of the C-arm, by co-registration and synchronization of the echocardiography probe on the X-ray image. Eco-X-ray fusion clearly delineated the localization of the PML on fluoroscopy (Panels A and B, see Supplementary data online, Videos S1 and S2) and facilitated the precise steering of the guide wire through the PML (Panel C, see Supplementary data online, Video S3). Eco-X-ray fusion also guided Amplatzer occluder device positioning (Panel D, see Supplementary data online, Video S4) and allowed the assessment of residual leak after the procedure. The device was successfully and uneventfully implanted and a great reduction of mitral regurgitation was achieved (Panels E and F, see Supplementary data online, Video S5).