What is the clinical evidence from this study?

Study design: Case Report. Population: Multiple perivalvular leaks after mitral valve replacement (n=1). Intervention: Real-time 3D transesophageal echocardiography and 3D printing guided transcatheter closure. Primary outcome: Procedural success and symptom resolution.

What question did this study set out to answer?

The aim is to accurately assess perivalvular leak (PVL) morphology following mitral valve replacement using imaging technologies.

April 27, 2026Journal of Cardiothoracic Surgery0 citationsOpen Access

Real-time three-dimensional transesophageal echocardiography and three-dimensional printing: detection of multiple perivalvular leaks after mitral valve replacement—a case report and literature review

ZWZhirong WangCentral South University QWQiuxian WanCentral South University CFChengming FanCentral South University

Key Result

The synergistic integration of real-time 3D transesophageal echocardiography and 3D printing successfully guided the transcatheter closure of multiple mitral perivalvular leaks via a left ventricular apical approach.

Key Points

The aim is to accurately assess perivalvular leak (PVL) morphology following mitral valve replacement using imaging technologies.
Utilized real-time three-dimensional transesophageal echocardiography and three-dimensional printing for evaluation.
Evaluated a 63-year-old woman with a history of mechanical mitral valve replacement.
Adjusted 3D printing parameters based on findings from RT-3D TEE for accurate visualization.
RT-3D TEE identified two adjacent perivalvular leaks, while initial 3D printing indicated only one.
Successful transcatheter closure of PVLs was performed guided by RT-3D TEE.
The combination of RT-3D TEE and 3D printing improved the understanding of complex PVL morphologies.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

1 adult (63-year-old woman) with a history of rheumatic heart disease, mechanical mitral valve replacement, tricuspid valvuloplasty, and left atrial reduction, presenting with symptomatic multiple perivalvular leaks (NYHA class III, hemolytic anemia).

Intervention

Transcatheter closure of mitral perivalvular leaks via left ventricular apical access using 8 mm and 7 mm symmetric ventricular septal defect (VSD) occluders, guided by real-time three-dimensional transesophageal echocardiography (RT-3D TEE) and 3D printing.

Outcome

Successful transcatheter closure of multiple perivalvular leaks with no residual regurgitation and resolution of heart failure symptoms at 6 months.

The integration of real-time 3D TEE and 3D printing provides complementary anatomical detail that can successfully guide transcatheter closure of complex, multiple perivalvular leaks.

Limitations

3D printing has limitations in accurately reproducing subtle anatomical details and hemodynamic properties.
Model fidelity depends heavily on material selection and printing techniques.
Dynamic changes in annular size throughout the cardiac cycle necessitate careful phase selection when constructing and measuring the virtual annulus.
3D printed model produced by external provider, limiting detailed printing parameters
RT-3D TEE is operator-dependent and requires significant expertise
Single case report cannot establish correlation between hemodynamic findings and clinical outcomes
Focused solely on mitral PVL
Lacks quantitative comparison of outcomes between imaging modalities

Abstract

Accurate assessment of perivalvular leak (PVL) morphology following valve replacement remains a significant clinical challenge. Precise characterization of PVL anatomy is essential, as different leak patterns require distinct management strategies. We report a case in which two complementary imaging modalities—real-time three-dimensional (RT-3D) transesophageal echocardiography (TEE) and three-dimensional (3D) printing technology—were successfully utilized to evaluate PVL morphology and guide the subsequent surgical approach. A 63-year-old woman with a history of mechanical mitral valve replacement was found to have a PVL on follow-up transthoracic echocardiography (TTE), but the number and morphology could not be fully determined. Initial 3D printing based on cardiac computed tomography angiography (CTA) depicted only one defect; however, subsequent RT-3D TEE revealed two adjacent leaks. Based on TEE findings, the 3D printing parameters were adjusted, allowing visualization of both leaks. These imaging results informed a tailored interventional strategy, and transcatheter closure of the mitral PVLs was successfully performed via left ventricular apical access under real-time TEE guidance. The synergistic integration of RT-3D TEE with color Doppler and 3D printing technology offers complementary strengths in the morphological assessment of complex or multiple PVLs, highlighting its potential clinical value in selected challenging cases.

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