Department of Medicine I, Universidad Complutense de Madrid, Madrid, Spain.
J Am Soc Echocardiogr. 2010 Jan;23(1):26-32. doi: 10.1016/j.echo.2009.09.028. Epub 2009 Nov 13.
The percutaneous closure of mitral paravalvular leaks has been reported in patients who are poor operative candidates. Unsuccessful percutaneous closure of leaks may be related to morphologic characteristics of the defects.
Ten patients were selected from a database for mitral dehiscence closure, in whom two-dimensional transesophageal echocardiography revealed inadequate leak closure. Another 4 patients with optimal results were also selected. Real-time three-dimensional transesophageal echocardiography (3DTEE) was performed in all of them.
Real-time 3DTEE enabled the determination of the locations and number of the leaks, as well as their shapes, lengths, widths, areas, and extent. We were also able to observe the position of the device (or devices) implanted during percutaneous closure.
According to this preliminary study, 3DTEE can improve understanding of the causes underlying failure of these techniques to reduce regurgitation secondary to a defect. This could improve patient selection and procedure results, but further studies are needed.
对于手术高危患者，经皮二尖瓣瓣周漏封堵术已被证实有效。然而，漏口封堵失败可能与漏口的形态学特征有关。
从二尖瓣瓣周漏封堵术数据库中选择了 10 名二维经食管超声心动图显示漏口封堵不佳的患者，另外还选择了 4 名封堵效果满意的患者作为对照。所有患者均进行实时三维经食管超声心动图（3DTEE）检查。
实时 3DTEE 可明确漏口的位置和数量、形状、长度、宽度、面积和范围，还可观察到经皮封堵术中植入装置（或多个装置）的位置。
初步研究表明，3DTEE 可提高对导致此类技术失败的原因的认识，从而减少因瓣周漏导致的反流。这有助于患者选择和手术结果的改善，但仍需要进一步研究。
