Intravascular ultrasound for transcatheter paravalvular leak closure

Transcatheter closure of paravalvular leaks requires precise assessment of the location, size, and shape of the defect. Transesophageal echocardiography plays an important role in this process. We encountered a case of a paravalvular leak at the aortic position after aortic and mitral valve replacement. It was impossible to detect the precise location of the paravalvular leak with transesophageal echocardiography because of an acoustic shadow from the mitral mechanical valve. Intraoperative use of intravascular ultrasound was useful for determining the morphology of the defect and evaluating the procedure during the operation.