Multiple Mitral Paravalvular Leak Closure With VSD Occluder in a High Surgical Risk Patient

Figures

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  Figure 1. TTE, TEE, and Fluoroscopic Images (A-C): Preoperative transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) images, and intraprocedural fluoroscopic images. (A) TTE parasternal long-axis view showing severe mitral regurgitation arising from aorto-mitral continuity. (B) TEE midesophageal 5-chamber view showing 2 paravalvular leak jets arising from aorto-mitral continuity (2 white asterisks). (C) Left ventricular angiogram (RAO 30° view) demonstrating 2 paravalvular leak jets (blue and black arrows). Ao = aorta; LA = left atrium; LV = left ventricle; MV = mitral valve; RAO = right anterior oblique.

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  Figure 2. TEE Images of the Mitral Valve and Paravalvular Leaks (A and B) 3-dimensional TEE reconstruction images depicting surgeon's view of the mitral valve. (A) Surgeon's view of the mitral valve, represented by the clock face diagram showing 2 paravalvular defects at 10 o’clock and 12 o’clock positions. (B) The paravalvular defects are indicated by the blue and black arrows. LAA = left atrial appendage; other abbreviations as in Figure 1.

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  Figure 3. Intraoperative Fluoroscopic and TEE Images (A and B) Intraoperative fluoroscopic and TEE images. (A) Fluoroscopic AP view. The 0.032-in straight-tip Terumo wires are being delivered through the Agilis steerable sheath (white asterisk) across both paravalvular leaks. (B) 3-dimensional TEE reconstructed image of the first KONAR-MF VSD occluder device (black asterisk) after deployment. The arrows represent the adjacent persisting paravalvular defect. AP = anteroposterior; Asc Ao = ascending aorta; RA = right atrium; other abbreviations as in Figure 1.

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  Figure 4. Post-Deployment TEE and Fluoroscopic Images (A to C): Post-deployment transesophageal echocardiography (TEE) and fluoroscopic images. (A) Both the KONAR-MF VSD occluder devices (blue and black asterisks) are shown. (B) TEE midesophageal 50° view with color Doppler, indicating absence of paravalvular leak. Arrows indicate the positions of both paravalvular devices. (C) Fluoroscopic image (RAO 30° view) of both KONAR-MF VSD occluder devices.

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  Figure 5. The KONAR-MF VSD Occluder Device KONAR-MF VSD occluder device (Picture credits: Lifetech Scientific, China).9