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Jędrzejek M, Kozłowski M, Peszek-Przybyła E, Jadczyk T, Pysz P, Wojakowski W, Smolka G. Mitral Paravalvular Leak 3D Printing from 3D-Transesophageal Echocardiography. Anatol J Cardiol 2023; 27:573-579. [PMID: 37288866 PMCID: PMC10541781 DOI: 10.14744/anatoljcardiol.2023.3008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Paravalvular leaks can be detected in almost 15% of patients after mitral valve prosthesis implantation. This complication can result in congestive heart failure and hemolysis. Despite advancements in non-invasive imaging, percutaneous closure of paravalvular leaks is not always successful. Therefore, efforts are made to improve treatment outcomes by using 3D-printed models of defects as pre-procedural support for interventional cardiologists. METHODS Retrospectively, 3D-transesophageal echocardiography recordings of 8 patients with clinically significant mitral paravalvular leaks were analyzed. Qlab Software was used to export DICOM images of each paravalvular leak channel, including surrounding tissue. Image segmentation was performed in 3D Slicer, a free, open-source software package used for imaging research. Models were printed to actual size with the poly jet Stratasys Objet 30 printer with a transparent, rigid material. RESULTS Duration of model preparation and printing, as well as the total cost, was calculated. Mean total time of model preparation was 430.5 ± 196 minutes. CONCLUSION 3D-printing from 3D-transesophageal echocardiography is technically feasible. Both shape and location of paravalvular leaks are preserved during model preparation and printing. It remains to be tested if 3D-printing would improve outcomes of percutaneous paravalvular leaks closure.
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Affiliation(s)
- Marek Jędrzejek
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michał Kozłowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ewa Peszek-Przybyła
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Jadczyk
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Pysz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Paravalvular Leak Echo Imaging before and during the Percutaneous Procedure. J Clin Med 2022; 11:jcm11113155. [PMID: 35683542 PMCID: PMC9180997 DOI: 10.3390/jcm11113155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Percutaneous device closure has become a valuable alternative to surgery in the management of paravalvular leaks. Consequently, imaging in these patients is currently not only meant to verify the hemodynamic significance of the lesion but also to assess the feasibility of transcatheter treatment. We present a methodology of comprehensive echocardiography assessment that allows for the selection of patients and plans the intervention. Next, procedure-oriented steps of echocardiography imaging, which are essential for eventual success, are reviewed.
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Choi JY, Suh YJ, Seo J, Choi KU, Hong GR, Lee S, Lee SH, Ha JW, Kim YJ, Shim CY. Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation. J Clin Med 2021; 10:jcm10020222. [PMID: 33435160 PMCID: PMC7826927 DOI: 10.3390/jcm10020222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/27/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. METHODS A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. RESULTS Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (β = 0.345; p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (β = 0.249; p = 0.036 and β = 0.467; p < 0.001, respectively). CONCLUSIONS Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea;
| | - Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jiwon Seo
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
| | - Kang-Un Choi
- Division of Cardiology, Department of Internal Medicine, Donguk University Gyeongju Hospital, Gyeongju 38067, Korea;
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
| | - Sak Lee
- Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (S.L.); (S.-H.L.)
| | - Seung-Hyun Lee
- Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (S.L.); (S.-H.L.)
| | - Jong-Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: (Y.J.K.); (C.Y.S.); Tel.: +82-2-2228-7400 (Y.J.K.); +82-2-2228-8453 (C.Y.S.); Fax: +82-2-393-3035 (Y.J.K.); +82-2-2227-7742 (C.Y.S.)
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.S.); (G.-R.H.); (J.-W.H.)
- Correspondence: (Y.J.K.); (C.Y.S.); Tel.: +82-2-2228-7400 (Y.J.K.); +82-2-2228-8453 (C.Y.S.); Fax: +82-2-393-3035 (Y.J.K.); +82-2-2227-7742 (C.Y.S.)
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