Closure of a paravalvular leak with real-time three-dimensional transesophageal echocardiography for accurate sizing...

Although closure of paravalvular leaks with Amplatzer occluders has been described in patients with increased perioperative risk, beneficial outcomes have not been consistently reported. Recent reports have described real-time three-dimensional transesophageal echocardiography (3D TEE) for facilitated guidance of the closure procedure. However, they did not focus on the critical issue of defect sizing. We report a case in which 3D TEE with off-line analysis of images to generate en face views of the mitral valve dehiscence allowed a simplified interrogation and definition of defect dimensions. 3D TEE was used for selection of the device size. The improved sizing was an important means to prevent device embolization as well as secure complete defect closure. Surprises with regard to the device size or the ability to anchor the device in a stable position were reduced.