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Volume : 13 Issue : 7 Year : 2021
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The Anatolian Journal of Cardiology Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective [Anatol J Cardiol]
Anatol J Cardiol. 2013; 13(7): 633-640 | DOI: 10.5152/akd.2013.185

Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective

Ozan Mustafa Gürsoy1, Mehmet Ali Astarcıoğlu1, Tayyar Gökdeniz1, Ahmet Çağır Aykan1, Ahmet Çağrı Aykan2, Zübeyde Bayram1, Beytullah Çakal1, Süleyman Karakoyun3, Gökhan Kahveci1, Nilüfer Ekşi Duran1, Mustafa Yıldız4, Mehmet Özkan1
1Clinic of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul-Turkey
2Clinic of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul-Turkey
3Clinic of Cardiology, Koşuyolu Heart Education and Research Hospital, İstanbul-Turkey
4Clinic of Cardiology, Istanbul University Institute of Cardiology, İstanbul-Turkey

Objective: Paravalvular leaks (PVLs) commonly occur in mitral prostheses. Real-time 3-dimensional transesophageal echocardiography (RT-3DTEE) may provide invaluable information about complex 3D anatomy of mitral PVLs compared to two-dimensional (2D) TEE findings. We, herein, aimed to evaluate the detailed description of anatomical characteristics of severe mitral PVLs using RT-3D TEE. Methods: Patients with diagnosis of severe mitral PVLs were simultaneously examined with 2D transthoracic echocardiography (TTE), 2D TEE, and RT-3D TEE. 3D characteristics of PVLs (localization, number, size, shape, etc.) were recorded and compared to 2D findings. Results were also compared with surgical findings. Results: The study comprised 47 cases (3 bioprosthesis, 44 mechanical) with 61 severe mitral PVLs. The most common PVL localizations were anterolateral commissure, posteromedial commissures and posterolateral region. The mean PVL width measured by 2D TEE was 3.1±1.3 (range; 2-7) mm and the mean width of defect measured by 3D TEE was 3.1±1.1 (range; 2-7) mm (p=0.7). The mean length of defect measured by 3D TEE was 11.1±6.5 mm. The most common defect type was ‘oval/round’ shaped (n=29; 48%). There were also 19 ‘crescentic’ (31%), 9 ‘slit like’ (15%), and 2 tunnel-like shaped defects. In 22 patients, the site and dimension of the PVLs were all confirmed surgically. Conclusions: RT-3D TEE permits detailed structural evaluation of the prosthesis and description of paravalvular leak morphology compared to 2D TEE. It may provide more accurate information to the clinician in decision making and may contribute to the success of the potential corrective procedures.

Keywords: Paravalvular mitral regurgitation, real-time three-dimensional transözofageal echocardiography

Ozan Mustafa Gürsoy, Mehmet Ali Astarcıoğlu, Tayyar Gökdeniz, Ahmet Çağır Aykan, Ahmet Çağrı Aykan, Zübeyde Bayram, Beytullah Çakal, Süleyman Karakoyun, Gökhan Kahveci, Nilüfer Ekşi Duran, Mustafa Yıldız, Mehmet Özkan. Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective. Anatol J Cardiol. 2013; 13(7): 633-640