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- Received December 8, 2008
- Accepted December 18, 2008
- Published online April 21, 2009.
A 61-year-old man with prior aortic and mitral valve replacement was referred to our institution with New York Heart Association functional class III heart failure. Live 3-dimensional (3D) transesophageal echocardiography (TEE) was performed, and a large paravalvular defect was identified along the lateral margin of the mechanical mitral prosthesis (A). With 3D TEE guidance, a trans-septal puncture of the atrial septum was performed. Panel Bdepicts the catheter arising from the atrial septum, looping within the left atrial appendage (black arrows), and crossing the defect into the left ventricle. Two patent ductus arteriosus occluder devices (Amplatzer, AGA Medical Corporation, Plymouth, Minnesota) were deployed sequentially to achieve a significant decrease in paravalvular defect size (C). Paravalvular regurgitation can cause significant morbidity (hemolysis, arrhythmia, heart failure); however, the risks of reoperation frequently prohibit surgery. Percutaneous paravalvular repair is becoming an increasingly attractive alternative, in part because of the structural detail and special orientation afforded by live 3D imaging (Online Videos 1, 2, 3, 4and 5).
- Received December 8, 2008.
- Accepted December 18, 2008.
- American College of Cardiology Foundation