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

Figures

• 

  Figure 1. Patient 1 periprocedural fusion of fluoroscopy and real-time 3D TEE. A – Preprocedural (top) and postprocedural (bottom) 3D TEE images of the mitral prosthesis. The arrows point to the orifice of the paravalvular leak (PVL) located at 2 o’clock (surgical view) and the occluder position after the deployment. B – Four fused fluoroscopy and real-time TEE images. The X-plain color Doppler images of PVL regurgitant flow (top) are oriented according to C-arm position (left bottom) and are fused with the fluoroscopy image (bottom). The location of PVL is marked by a red circle. C – Guidewire passage through the paravalvular defect. The fluoroscopy image (on the bottom) demonstrates wire crossing the red circle; 3D TEE image (top) confirms the guidewire passage through the defect. The arrow in the 3D TEE image shows the guidewire crossing the defect Ao – position of the aorta.

• 

  Figure 2. Patient 2 periprocedural fusion of fluoroscopy and real-time 3D TEE. A – The preprocedural color flow Doppler (top) and 3D images (bottom) demonstrates bileaflet mechanical mitral valve prostheses (P) and the paravalvular leak located at 2 o’clock (arrow). B – Two dimensional X-plain images (top), X-plain echo images are oriented according to C-arm position (left bottom) and are fused with the fluoroscopy image (right bottom). Position of the prostheses is marked by a green circle in all images. The red circle identifies the location of the defect. C – Guidewire passage through the paravalvular defect. The fluoroscopy image (on the bottom) demonstrates wire crossing the red circle; 3D TEE image (top) confirms the guidewire passage through the defect. The arrow in the 3D TEE image shows the guidewire crossing the defect Ao – position of the aorta.

• 

  Figure 3. Patient 3 periprocedural fusion of fluoroscopy and real-time 3D TEE. A – The preprocedural 3D TEE color flow Doppler image (top) and 3D TEE image (bottom) with paravalvular defects closed with occluders. Arrows point to the defects. B – Real-time 3D TEE image (top left and bottom left) demonstrating ventricular perspective of the mitral prosthesis where colored (red, white, green) circles indicate paravalvular defects. Realtime 3D TEE image (top right) demonstrates atrial perspective of the mitral prosthesis where colored (red, white, green) circles indicate paravalvular defects. Fused fluoroscopy and real-time TEE image (bottom right) demonstrates wire crossing the green circle; 3D TEE image (top right) confirms the guidewire passage through the defect (arrow pointing to the guidewire) Ao – position of the aorta.