Tekin Meltem, Güler Gamze Babur, Çiçek Mehmet, Tanboğa İbrahim Halil, Pysz Piotr, Güler Arda, Demir Ali Rıza, Efe Yusuf, Atmaca Sezgin, Pay Dilara, Kalkan Ali Kemal, Ertürk Mehmet
TC Saglik Bakanligi Mehmet Akif Ersoy Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi, Istanbul, Turkey.
Hisar Hospital Intercontinental, Istanbul, Turkey.
Catheter Cardiovasc Interv. 2025 May;105(6):1304-1310. doi: 10.1002/ccd.31448. Epub 2025 Feb 20.
Clinically significant paravalvular leak (PVL) may complicate both surgical and transcatheter valve implantation. Percutaneous PVL closure (PPVLC) is becoming an increasingly attractive alternative to redo surgery, with demonstrated lower mortality and morbidity rates. Echocardiographic techniques are crucial for accurate diagnosis, defect sizing, and determining the appropriate size of the sealing devices.
There is no consensus on the optimal imaging modality for PVLs. We aimed to compare transthoracic and transesophageal echocardiographic measurements to accurately determine defect size and estimate device size.
We reviewed hospital records to identify patients diagnosed with moderate to severe and severe PVL from 2018 to 2024. A total of 81 patients who underwent PPVLC were evaluated. Eight of these patients were excluded due to unsuccessful PPVLC, leaving 73 patients who were successfully treated. The defect size for all patients was evaluated using 2D transthoracic echocardiography (TTE), 2D transesophageal echocardiography (TEE), direct 3D TEE cropped volume rendering vena contracta (VC) measurement, and 3D TEE multiplanar reconstruction (3D TEE MPR).
Among the 73 patients, 42 underwent aortic PPVLC and 31 underwent mitral PPVLC. Proportional odds logistic regression analysis identified 3D TEE MPR measurement as the strongest predictor of device size accuracy, both overall and within the aortic/mitral subgroups. In the mitral subgroup, the predictive power of direct 3D TEE cropped volume rendering VC measurement and 3D TEE MPR measurement were similar. Furthermore, a cut-off value of 7 mm was identified for hemodynamically significant jets as measured by 3D methods.
Our findings suggest that using 3D TEE MPR significantly improves the accuracy of device size selection in both mitral and aortic PVL. Additionally, direct 3D TEE cropped volume rendering VC measurement can serve as a viable alternative for patients with mitral PVL.
具有临床意义的瓣周漏（PVL）可能会使外科手术和经导管瓣膜植入术变得复杂。经皮PVL封堵术（PPVLC）正成为再次手术越来越有吸引力的替代方案，其死亡率和发病率较低。超声心动图技术对于准确诊断、缺损大小测量以及确定封堵装置的合适尺寸至关重要。
对于PVL的最佳成像方式尚无共识。我们旨在比较经胸和经食管超声心动图测量，以准确确定缺损大小并估计装置尺寸。
我们回顾了医院记录，以识别2018年至2024年被诊断为中度至重度和重度PVL的患者。共有81例接受PPVLC的患者接受了评估。其中8例患者因PPVLC未成功而被排除，剩下73例成功接受治疗的患者。所有患者的缺损大小均使用二维经胸超声心动图（TTE）、二维经食管超声心动图（TEE）、直接三维TEE裁剪容积再现法测量缩流宽度（VC）以及三维TEE多平面重建（三维TEE MPR）进行评估。
在这73例患者中，42例行主动脉瓣PPVLC，31例行二尖瓣PPVLC。比例优势逻辑回归分析确定，三维TEE MPR测量是装置尺寸准确性的最强预测指标，无论是总体还是在主动脉瓣/二尖瓣亚组中。在二尖瓣亚组中，直接三维TEE裁剪容积再现法测量VC和三维TEE MPR测量的预测能力相似。此外，通过三维方法测量，血流动力学显著的射流的截断值为7毫米。
我们的研究结果表明，使用三维TEE MPR可显著提高二尖瓣和主动脉瓣PVL中装置尺寸选择的准确性。此外，直接三维TEE裁剪容积再现法测量VC可作为二尖瓣PVL患者的可行替代方法。
