case_images: PMC7493271_01
case_images: (a) 3D image of pre-procedural color flow TEE Doppler shows prosthetic aortic valve paravalvular leak (between the sewing ring and the aortic wall) at the anterolateral aspect. The arrow points to the leakage site. (b) 3D TEE images showing plug placement (ventricular view) of aortic valve. The arrow shows the plug position after placement.
case_images: 10.1177_2048004020947290-fig1.jpg
case_images: PMC7493271_01_10.1177_2048004020947290-fig1.jpg
case_images: fig1-2048004020947290
case_images: Transesophageal echocardiogram (TEE) revealed the bioprosthetic valve cusps had normal excursion; however, a moderate peri-valvular leak was noted (Figure 1(a)). TEE (Figure 1(b)), and aortography showed no aortic insufficiency (AI). The post-procedure clinical course of the patient was smooth.
case_images: (a) 2D TEE images show prosthetic aortic valve with exact leakage site (defect) marked by the green circle. The arrows (2 A,B) point to the leakage site. (b) 2D TEE images are oriented according to C-arm position and fused with fluoroscopy image (merging technique) using the EchoNavigator system, so that the exact leakage site (green circle) can appear on fluoroscopy, thus facilitating the passage of the wire and plug placement.
case_images: 10.1177_2048004020947290-fig2.jpg
case_images: PMC7493271_01_10.1177_2048004020947290-fig2.jpg
case_images: fig2-2048004020947290
case_images: TEE probe in the fluoroscopy field. This helped the fusion software EchoNavigator system to identify the TEE probe and adjust its position with the table and the angulation of the C-arm. Through this way, the c-arm and TEE probe can be manipulated with the fused images maintained. This technology helped identify the exact site, size, depth and shape of the paravalvular leak in the left coronary sinus, which was marked in the Echo Navigator system facilitating passage of a guidewire across the leak (Figure 2(a) and (b)).