Sébastien Hascoet1, Grzegorz Smolka2, Francois Bagate3, Julien Guihaire4, Agathe Potier4, Khaled Hadeed5, Yoan Lavie-Badie6, Hélène Bouvaist7, Claire Dauphin8, Fabrice Bauer9, Mohammed Nejjari10, Remy Pillière11, Eric Brochet12, Lionel Mangin13, Guillaume Bonnet14, Vlad Ciobotaru15, Guillaume Leurent16, Najib Hammoudi17, Adel Aminian18, Clement Karsenty19, Christian Spaulding20, Sebastien Armero21, Frederic Collet22, Didier Champagnac23, Julien Ternacle24, Martin Kloeckner4, Benoit Gerardin4, Marc-Antoine Isorni4. 1. Faculté de médecine Paris-Sud, hôpital Marie-Lannelongue, université Paris-Sud, Paris-Saclay, 92350 Le Plessis-Robinson, France. Electronic address: s.hascoet@hml.fr. 2. Department of cardiology, medical university of Silesia, 40055 Katowice, Poland. 3. Centre de réanimation et d'intervention cardio-vasculaire, clinique Ambroise-Paré, 92200 Neuilly-sur-Seine, France; Hôpital Henri-Mondor, cardiologie, Assistance publique des Hôpitaux de Paris, Inserm U955, 94010 Créteil, France. 4. Faculté de médecine Paris-Sud, hôpital Marie-Lannelongue, université Paris-Sud, Paris-Saclay, 92350 Le Plessis-Robinson, France. 5. Hôpital des enfants, cardiologie pédiatrique, centre hospitalier universitaire de Toulouse, 31059 Toulouse, France. 6. Hôpital Rangueil, cardiologie, centre hospitalier universitaire de Toulouse, 31059 Toulouse, France. 7. Hôpital La Tronche, cardiologie, centre hospitalier universitaire de Grenoble-Alpes, 38700 Grenoble, France. 8. Hôpital Gabriel-Montpied, cardiologie, centre hospitalier universitaire de Clermont-Ferrand, 63000 Clermont-Ferrand, France. 9. Cardiologie, centre hospitalier universitaire de Rouen, 76031 Rouen, France. 10. Centre cardiologique du nord, 93200 Saint-Denis, France. 11. Centre de réanimation et d'intervention cardio-vasculaire, clinique Ambroise-Paré, 92200 Neuilly-sur-Seine, France. 12. Hôpital Bichat, Assistance publique des Hôpitaux de Paris, 75018 Paris, France. 13. Cardiologie, centre hospitalier régional, 74370 Annecy-Genevois, France. 14. Hôpital Timone, cardiologie, Assistance publique des Hôpitaux de Marseille, 13005 Marseille, France. 15. Cardiologie, hôpital Prive-Les-Franciscaines, 30032 Nîmes, France. 16. Cardiologie, centre hospitalier universitaire de Rennes, 35000 Rennes, France. 17. Hôpital Pitié-Salpetrière, cardiologie, Assistance publique des Hôpitaux de Paris, 75013 Paris, France. 18. Cardiologie, hôpital universitaire de Charleroi, 6042 Charleroi, Belgique. 19. Hôpital des enfants, cardiologie pédiatrique, centre hospitalier universitaire de Toulouse, 31059 Toulouse, France; Hôpital Rangueil, cardiologie, centre hospitalier universitaire de Toulouse, 31059 Toulouse, France; Hôpital Européen-Georges-Pompidou, cardiologie, Assistance publique des Hôpitaux de Paris, Université Paris Descartes, Inserm U 970, 75015 Paris, France. 20. Hôpital Européen-Georges-Pompidou, cardiologie, Assistance publique des Hôpitaux de Paris, Université Paris Descartes, Inserm U 970, 75015 Paris, France. 21. Cardiologie, hôpital privé Clairval, 13009 Marseille, France; Cardiologie, hôpital européen de Marseille, 13003 Marseille, France. 22. Cardiologie, hôpital privé Clairval, 13009 Marseille, France. 23. Cardiologie, clinique du Tonkin, 69100 Villeurbanne, France. 24. Hôpital Henri-Mondor, cardiologie, Assistance publique des Hôpitaux de Paris, Inserm U955, 94010 Créteil, France.
Abstract
BACKGROUND: Percutaneous paravalvular leak (PVL) closure has emerged as a palliative alternative to surgical management in selected high-risk patients. Percutaneous procedures are challenging, especially for mitral PVL. Accurate imaging of the morphologies of the defects is mandatory, together with precise guidance in the catheterization laboratory to enhance success rates. AIMS: To describe imaging modalities used in clinical practice to guide percutaneous PVL closure and assess the potential of new imaging tools. METHODS: Data from the 'Fermeture de Fuite paraprothétique' (FFPP) register were used. The FFPP register is an international multi-institutional collaborative register started in 2017 with a retrospective and a prospective part. A descriptive analysis of multimodality imaging used to guide PVL closure in clinical practice was performed. RESULTS: Data from 173 procedures performed in 19 centres from three countries (France, Belgium and Poland) were collected, which included eight cases of PVL following transcatheter valve replacement. Transoesophageal echocardiography was used in 167 cases (96.5%) and 3D echocardiography in 87.4% of cases. In one case, 3D-echocardiography was fused with fluoroscopy images in real time using echonavigator software. Details about multimodality imaging were available from a sample of 31 patients. Cardiac computed tomography (CT) was performed before 10 of the procedures. In one case, fusion between preprocedural cardiac CT angiography data and fluoroscopy data was used. In two cases, a 3D model of the valve with PVL was printed. CONCLUSION: Echocardiography, particularly the 3D mode, is the cornerstone of PVL imaging. Other imaging modalities, such as cardiac CT and cardiac magnetic resonance imaging, may be of complementary interest. New techniques such as imaging fusion and printing may further facilitate the percutaneous approach of PVLs.
BACKGROUND: Percutaneous paravalvular leak (PVL) closure has emerged as a palliative alternative to surgical management in selected high-risk patients. Percutaneous procedures are challenging, especially for mitral PVL. Accurate imaging of the morphologies of the defects is mandatory, together with precise guidance in the catheterization laboratory to enhance success rates. AIMS: To describe imaging modalities used in clinical practice to guide percutaneous PVL closure and assess the potential of new imaging tools. METHODS: Data from the 'Fermeture de Fuite paraprothétique' (FFPP) register were used. The FFPP register is an international multi-institutional collaborative register started in 2017 with a retrospective and a prospective part. A descriptive analysis of multimodality imaging used to guide PVL closure in clinical practice was performed. RESULTS: Data from 173 procedures performed in 19 centres from three countries (France, Belgium and Poland) were collected, which included eight cases of PVL following transcatheter valve replacement. Transoesophageal echocardiography was used in 167 cases (96.5%) and 3D echocardiography in 87.4% of cases. In one case, 3D-echocardiography was fused with fluoroscopy images in real time using echonavigator software. Details about multimodality imaging were available from a sample of 31 patients. Cardiac computed tomography (CT) was performed before 10 of the procedures. In one case, fusion between preprocedural cardiac CT angiography data and fluoroscopy data was used. In two cases, a 3D model of the valve with PVL was printed. CONCLUSION: Echocardiography, particularly the 3D mode, is the cornerstone of PVL imaging. Other imaging modalities, such as cardiac CT and cardiac magnetic resonance imaging, may be of complementary interest. New techniques such as imaging fusion and printing may further facilitate the percutaneous approach of PVLs.