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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:665 - Vol. 70 Num.08 DOI: 10.1016/j.rec.2016.11.019

Echo- X Ray Fusion in Paravalvular Leak Closure

Manuel Barreiro-Pérez a,, Ignacio Cruz-González a, Pedro L. Sánchez a

a Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biosanitaria de Salamanca (IBSAL), Salamanca, Spain

Article

In patients with paravalvular leaks, between 1% and 5% experience clinical events, and the most common indications for closure are heart failure and hemolysis. The percutaneous approach reduces morbidity and mortality and has become the first-line option. Coordination of echocardiography and fluoroscopy monitoring is made easier with the use of a real-time fusion system (EchoNavigator, Philips). The movement of the C-arm is synchronized with the transesophageal probe, allowing the 2 techniques to be overlaid. The 2-dimensional or 3-dimensional echocardiographic view is automatically shown on the fluoroscopy screen, according to the position of the X-ray tube. The paravalvular leak is located using color Doppler (Figure 1 and Figure 1) and can be marked: the marker appears overlaid on the fluoroscopy screen (Figure 1 and Figure 1) and maintains its 3-dimensional position independently of the movement of the C-arm.

Figure 1.

This system is especially useful in more complex cases, such as closure of a paravalvular leak around a radiolucent bioprosthesis (Figure 2 and Figure 2). For example, through the use of 2-dimensional orthogonal (X-plane) echocardiography, the fusion system can provide the interventional cardiologist with a reference plane at the moment of fitting and deploying the closure device (Figure 2 and Figure 2). Another situation that could potentially make use of this technology is the treatment of residual paravalvular leaks after transcatheter aortic valve implantation (Figure 3), as the presence of such leaks affects survival and readmission at follow-up.

Figure 2.

Figure 3.

Corresponding author: manuelbarreiroperez@gmail.com

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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