Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure

Introduction

Real-time 3D transesophageal echocardiography (TEE) with cardiac fluoroscopy X-ray imaging is well introduced into practice and is used to monitor and assist catheter-based cardiac operations [1–6].
Cardiac fluoroscopy imaging is useful to monitor and control delivery tools into the desired site of the heart during transcatheter closure of paravalvular defects [3, 7, 8]. Fluoroscopy is superior to 3D TEE in visualization of the catheters, wires, devices, and calcified and metallic structures. The main disadvantages of fluoroscopy are the inability to determine the three-dimensional anatomy of intracardiac tissues, exposure to radiation and the need for contrast media.
3D TEE is a standard method to visualize intracardiac structural pathology and measure its hemodynamic significance. It is also used to control intracardiac manipulation of various instruments as well as paravalvular leak closure devices [8]. 3D TEE provides spatial intracardiac anatomy imaging in multiple planes, but its advantages are limited by echo shadowing, which reduces visualization of the catheters and metallic structures. Also experienced personnel are needed to achieve high quality 3D imaging and guide the procedures [7].
Merging these two imaging techniques combines the advantages of fluoroscopy and 3D TEE during paravalvular leak closure. As to date there are no studies comparing mitral paravalvular leak closure with or without fusion technology, we hypothesize that periprocedural fusion of cardiac fluoroscopy and real-time 3D TEE may make intracardiac procedures more controlled, precise and easier. Also it may reduce patients’ and professionals’ exposure to radiation [7].
We present three cases of transapical catheter-based mitral paravalvular leak closure. All patients were treated with devices specifically designed and manufactured by Occlutech Holding, Switzerland for paravalvlar leak closure. The Occlutech® Paravalvular Leak Device represents a novel device with unique rectangular- and square-shaped designs. Occlutech® Paravalvular Leak Device was CE marked in 2014 and is the first transcatheter device indicated and approved for aortic and mitral PVL closure. Procedures were performed with the assistance of fusion (EchoNavigator system, Phillips Medical Systems, Netherlands) of cardiac fluoroscopy imaging (Phillips AlluraClarity, Phillips Medical Systems, Netherlands) and real-time 3D TEE (Phillips Epiq7, Phillips Medical...


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