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European Journal of Echocardiography Advance Access originally published online on March 8, 2009
European Journal of Echocardiography 2009 10(4):572-575; doi:10.1093/ejechocard/jep019
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Three-dimensional echocardiography-guided repair of severe paravalvular regurgitation in a bioprosthetic and mechanical mitral valve

Amer M. Johri1,*, Kibar Yared1, Ronen Durst1, Roberto J. Cubeddu2, Igor F. Palacios2, Michael H. Picard1 and Jonathan Passeri1

1 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard University, 55 Fruit Street, Boston, MA, USA
2 Cardiac Catheterization Laboratory, Massachusetts General Hospital, Harvard University, 55 Fruit Street, Boston, MA, USA

Received 12 December 2008; accepted after revision 10 February 2009; online publish-ahead-of-print 8 March 2009.

* Corresponding author. Tel: +1 617 726 0995; fax: +1 617 726 8383. E-mail address: amerjohri{at}gmail.com


  Abstract

Severe paravalvular mitral regurgitation is a rare but important complication of mitral valve replacement, often producing symptoms associated with refractory heart failure or haemolysis. Explantation and replacement of the prosthesis are required in some patients but may not be possible in patients with high risk of morbidity or mortality with re-operation. We present two patients with symptomatic paravalvular mitral regurgitation who were deemed too high risk for re-operation because of multiple previous sternotomies and comorbidities. Percutaneous three-dimensional (3D) echocardiography-guided repair with septal occluder devices was undertaken in the first case of a paravalvular defect adjacent to a mitral bioprosthesis and in the second case adjacent to a mechanical mitral prosthesis. Both cases illustrate the advantage 3D echocardiography provides by allowing en-face views of the paravalvular leak and unique views of the catheter and device placement. The second case further demonstrates the novel use of full volume colour to define the extent of the regurgitant jet and provides information critical to device sizing and placement.

Keywords: Paravalvular regurgitation; Three-dimensional echocardiography


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