PMC7849847_01
A: TEE transgastric long axis aortic view showed severe paravalvular leak. B Deployment of the distal disc (LV disc) of an 10 mm muscular VSD device. C: Deployment of the proximal disc (aortic disc) of the device. D: Second wire for another device. E: Released both devices.
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Transesophageal echocardiogram (TEE) transgastric long axis aortic view revealed severe paravalvular leak (PVL) around the aortic prosthesis (Fig. 1A) evidenced by diastolic reversal in the thoracic and abdominal aorta and vena contracta of 0.6 cm. The 8 F delivery sheath easily crossed the defect, 10 mm muscular VSD deployed without affecting the mechanics of the AV (Fig. 1B and C). A vascular plug II size 12 was successfully sealed the residual leakage (Fig. 1D). Both devices were released (Fig. 1 E) with trace residual aortic PVL.
A: Severe TR, failed annuloplasty ring. B: 2D measurement of TV ring. C: 3D C shaped TV ring. D: Deployment of 29 Sapien valve in TV ring. E: Balloon inflation of the valve. F: Residual moderate PVL.
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Severe TR showed at (Fig. 2A, B, and 2C). Sapien 3 valve size 29 was selected based on surgical report of the ring type supported by the online mitral VIV application and confirmed by the 2D echo measurements of the TV ring. Sapien 29 mm valve deployed in the TV ring and positioned 85% ventricular and 15% atrial (Fig. 2D and E). After valve deployment residual significant PVL noted (Fig. 2F) so the valve was re-inflated after adding additional 4 mm to achieve 31 mm final valve size.
A: Wire passed the residual PVL. B: deployment of a 10 mm muscular VSD device. C: Released PVL closure device. D: 3D of the implanted valve and the PVL closure device. E: Residual trace PVL.
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TV PVL (Fig. 3A). To eliminate the residual PVL the defect was crossed and a muscular VSD device size 10 mm was deployed between the TV ring and the Sapient valve (Fig. 3B, C, and 3D). The mean RA-RV gradient by Doppler was 4 mmHg, Residual trace TV PVL showed at (Fig. 3E) The patient was treated with warfarin due to the presence of left-sided mechanical valves.