[Perivalvular leak assessment and closure: role of real-time three-dimensional transesophageal echocardiography]

Perivalvular leak following implant of aortic or mitral prosthetic valves or rings is a relatively common complication, sometimes leading to significant clinical and hemodynamic consequences, such as severe valvular insufficiency, heart failure and hemolysis. In these cases, a second surgical operation, which typically involves the replacement of the dehiscent prosthesis, is the procedure of choice, but sometimes it cannot be performed. The alternative to reoperation can be the percutaneous closure of the perivalvular leak guided by transesophageal echocardiography before and during the closure procedure. In this review, the current role of echocardiography in the study of perivalvular leaks, with particular reference to guiding percutaneous transcatheter closure, is discussed. Also, the advantages and limitations of conventional two-dimensional and real-time three-dimensional transesophageal echocardiography are compared.