Turk Kardiyol Dern Ars. 2009; 37(6): 371-377 | DOI: 10.5543/tkda.2009.89914

The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement

Mustafa Yıldız, Nilüfer Ekşi Duran, Tayyar Gökdeniz, Hasan Kaya, Mehmet Özkan
Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul

OBJECTIVES
Two-dimensional (2D) echocardiographic approaches are not sufficient to determine the origin of paravalvular leak (PVL) that occurs after prosthetic mitral valve replacement (MVR). In this study, we investigated the role of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in detecting the origin and size of PVL occurring after prosthetic MVR.

STUDY DESIGN
The study included 13 patients (7 females; 6 males; mean age 56±10 years; range 37 to 71 years) who developed PVL within a mean of 8.3±3.8 years following mechanical prosthetic MVR. Nine patients (69.2%) had atrial fibrillation, and four patients (30.8%) had normal sinus rhythm. Four patients (30.8%) had hemolysis. Paravalvular leak was mild, moderate, and severe in two, six, and five patients, respectively. Real-time 3D TEE was performed using a 3D matrix-array TEE transducer immediately after detection of PVL on 2D TEE examination. Localization of PVL was made using a clock-wise format in relation to the aortic valve and the size of dehiscence was measured.

RESULTS
The mean PVL width measured by 2D TEE was 3.00±0.92 mm. The mean length of dehiscence was 13.6±8.8 mm, and the mean width was 3.88±2.04 mm on RT-3D TEE. The PVLs were mainly localized in the posterior and anterior annular positions between 12 to 03 hours (n=7) and 06 to 09 hours (n=3) on RT-3D TEE, respectively, which corresponded to the posteromedial or anterolateral sectors of the posterior annulus.

CONCLUSION
Considering that only the width of the PVL defect can be assessed by 2D TEE, delineation by RT-3D TEE includes the localization of PVL together with the length and width of the defect.

Keywords: Echocardiography, three-dimensional, echocardiography, transesophageal; heart valve prosthesis/adverse effects; mitral valve insufficiency/etiology; prosthesis failure.

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