A major advantage of real-time 3D transesophageal echocardiography (RT3D TEE) is its ability to provide realistic and comprehensive views of cardiac valves and congenital abnormalities [Lang RM et al. J Am Col Cardiol. 2006]. It also allows immediate feedback on the effectiveness of surgical interventions. Bruno Bochard-Villanueva, MD, Department of Cardiology, University General Hospital of Valencia, Valencia, Spain, discussed the results of a single-center study in which RT3D TEE was superior to 2D TEE in the assessment of mitral periprosthetic leaks and in guiding percutaneous closure of these leaks.

The diagnosis and treatment of periprosthetic mitral valve is challenging. This case series comprised 26 patients (mean age, 69.6 years; 65% women) diagnosed with significant mitral periprosthetic leak by transthoracic echocardiography between March 2011 and February 2014. Both 2D and RT3D TEE were performed on all patients and the results were analyzed for the number of leaks, leak location(s), the effective regurgitant orifice area (EROA) by proximal convergence method (2D), and direct planimetry using multiplanar reconstruction software (3D). The sphericity index was obtained by the ratio between the largest and smallest diameters of the leak.

The most common leak location was posterior (13 patients), followed by septal (6 patients), lateral (5 patients), and anterior (2 patients). EROA could not be calculated in 9 patients using 2D TEE but was calculable in all patients using RT3D TEE. In addition, when calculated using RT3D TEE, the EROA was significantly (P < .01) greater (0.31 ± 0.19 cm²) than that when calculated using 2D TEE (0.24 ± 0.13 cm²). The sphericity index was < 1.5 in only 2 patients. The use of RT3D TEE permitted percutaneous closure of the leak in 8 patients, and the major diameter was used to choose the device size. Table 1 compares the patients in this study based on the results of 2D and RT3D TEE.

In this study, RT3D TEE allowed for an accurate diagnosis of the EROA dimension, proper choice of closure device, and guided percutaneous leak closure.