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Successful Closure of Paravalvular Leak Using Computed Tomography Image Fusion and Planning With 3-Dimensional Printing.

ABSTRACT: The presence of moderate to severe paravalvular leak increases mortality. We present a case of giant paravalvular leak closure using the 3-dimensional printing model to assess the success of the device to be used for its closure, computed tomography was performed for planning and guiding the procedure by image fusion. (Level of Difficulty: Advanced.).

SUBMITTER: Espinoza Rueda MA

PROVIDER: S-EPMC8743814 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Successful Closure of Paravalvular Leak Using Computed Tomography Image Fusion and Planning With 3-Dimensional Printing.

Espinoza Rueda Manuel A MA Alcántara Meléndez Marco A MA González Roberto Muratalla RM Jiménez Valverde Arnoldo S AS García García Juan F JF Rivas Gálvez Ronald E RE Esparza Tomas Hernández TH Rodríguez Gustavo G Sandoval Castillo Luz D LD Merino Rajme José A JA

JACC. Case reports 20211207 1

The presence of moderate to severe paravalvular leak increases mortality. We present a case of giant paravalvular leak closure using the 3-dimensional printing model to assess the success of the device to be used for its closure, computed tomography was performed for planning and guiding the procedure by image fusion. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 35036941

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Project description:BackgroundClosure of a percutaneous paravalvular leak (PVL) is a technically challenging procedure because of the specific anatomy postoperatively and the complex catheter techniques required. Transesophageal echocardiography (TEE) and three-dimensional (3D) printing might be helpful in identifying complex anatomical structures and the procedural design.ObjectivesThe purpose of this study was to review our experiences with transcatheter closure of PVL guided by TEE and 3D (TEE&3D) printing.MethodsA total of 166 patients with PVL after surgical valve replacement underwent transcatheter closure, from January 2015 through December 2020. Among these patients, 68 had preoperative guidance from TEE&3D printing. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up period was 36 (3-70) months.ResultsAcute procedural success was achieved in 154/166 (92.8%) patients; of these, 64/68 (94.1%) had TEE&3D guidance and 90/98 (91.8%) had transthoracic echocardiography (TTE) guidance. No hospital deaths occurred. All patients having percutaneous procedures were given local anesthesia, while 13 patients having transapical procedures were given general anesthesia. Multiple approaches were used, including transfemoral, transapical, and transseptal via the arteriovenous loop. We also deployed multiple devices, including the Amplatzer Vascular Plug II (AVP II), the Amplatzer duct occluder II, the patent ductus arteriosus (PDA) occluder, and the Amplatzer muscular ventricular septal defect occluder. Those cases guided by TEE&3D printing had shorter procedural times compared with those guided by TTE [(61.2 ± 23.4) vs. (105.7 ± 53.9) min, p < 0.05]. The fluoroscopic time was also shorter for operations guided by TEE&3D printing compared with those guided by TTE alone [(18.5 ± 11.4) vs. (27.3 ± 5.6) min, p < 0.05]. The complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. There was no significant difference in the incidence of complications between the 2 groups.ConclusionTransesophageal echocardiography and 3D printing show advantages compared with standalone TTE in guiding the transcatheter closure of PVL with shorter procedural and fluoroscopic times. This minimally invasive treatment could provide reliable outcomes in selected patients.Clinical trial registration[www.ClinicalTrials.gov], identifier [NCT02917980].

Project description:BACKGROUND:Three-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may therefore provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Three-dimensional (3D) modelling may provide benefit for optimal preoperative TAVI planning. The goal of this study is to assess the utility of 3D modelling in the prediction of paravalvular leak (PVL) post TAVI. METHODS:Retrospective analysis of five patients who underwent TAVI at our center. Pre-operative cardiac gated CT images were utilized to create a 3D printed model with true size aortic root dimensions, including the coronary artery ostium location and left ventricular outflow tract. Deployment of the corresponding model and size TAVI valve into the created 3D model at a similar depth of implantation via fluoroscopy was performed for each patient. Degree of PVL was assessed using a closed system with water infusion under pressure over a duration of 5 s. Correlation was made between the volume obtained in the closed loop model during the pressurized period and the degree of PVL reported on the patients post TAVI placement on transthoracic echocardiogram. RESULTS:One female, and four males (age in years ranged from 68 to 87) underwent successful TAVI (0% 30-day mortality). PVL on post procedure TTE ranged from none to trivial. Successful deployment of TAVI valves inside the 3D model occurred in all cases. The average volume of water collected on three trials over 5 s ranged between 19.1-24.1?ml A multivariate linear regression showed significant association between the degree of PVL reported on post-operative transthoracic echocardiogram and the amount of volume detected in the 3D model (difference: -3.9657, 95% CI: (-?4.6761,-3.2554), p?<?0.001). CONCLUSIONS:Our experiments show that replicated 3D models have potential clinical utilization in predicting PVL in the TAVI population. Future research into the role of 3D modelling in the field of TAVI should continue to be explored.

Dataset Information

Successful Closure of Paravalvular Leak Using Computed Tomography Image Fusion and Planning With 3-Dimensional Printing.

Publications

Successful Closure of Paravalvular Leak Using Computed Tomography Image Fusion and Planning With 3-Dimensional Printing.

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