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Cardiovascular Images
August 19, 2020

Guided by the Light—Transillumination of a Paravalvular Leak

Author Affiliations
  • 1Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
JAMA Cardiol. 2020;5(8):e203260. doi:10.1001/jamacardio.2020.3260

What pathology of the prosthetic valve is featured in this 3-dimensional echocardiogram? A 42-year-old woman who had a history of bioprosthetic aortic and mitral valve replacement 1 year prior because of endocarditis was noted to have a new systolic murmur. Transesophageal echocardiography showed focal dehiscence of the mitral valve with severe paravalvular mitral regurgitation. After a multidisciplinary discussion between the Departments of Cardiothoracic Surgery and Interventional Cardiology, the decision was made to pursue a percutaneous, transesophageal echocardiography–guided paravalvular leak closure. The bioprosthetic mitral valve was imaged from both the atrial and ventricular perspectives. Transillumination (Philips), a new 3-dimensional rendering tool that uses a movable light source to enhance depth perception, was used to localize the paravalvular leak, which was best visualized from the left ventricular perspective (Figure, A).1 Using a transapical approach, the paravalvular leak was successfully plugged with a 6 × 4-mm Amplatzer occluder (Abbott Vascular) (Figure, B), with complete resolution of the paravalvular mitral regurgitation.

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