Description and assessment of a common reference method for fluoroscopic and transesophageal echocardiographic localization and guidance of mitral periprosthetic transcatheter leak reduction.
OBJECTIVE
This study sought to describe and compare a novel fluoroscopic method and a 2-dimensional transesophageal echocardiographic (TEE) method to localize mitral periprosthetic leaks (PPLs) for transcatheter reduction.


BACKGROUND
Transcatheter reduction of significant regurgitation represents a modern and attractive alternative to surgery for the treatment of mitral PPL in high-risk patients. Accurate localization and precise communication between the echocardiographer and the interventional cardiologist are essential for procedural success.


METHODS
We analyzed TEE and fluoroscopic studies of patients with mitral PPL who underwent multiplane 2-dimensional TEE-guided transcatheter reduction in our institution. Periprosthetic leaks were routinely localized using the "surgeon's-view" time-clock method during periprocedural TEE assessments. The 2-dimensional TEE examinations were later retrospectively reviewed by an echocardiographer blinded to procedural TEE findings. A corresponding surgeon's-view time-clock method was plotted for fluoroscopic PPL localization. Using this fluoroscopic method, offline fluoroscopic images were reviewed by an independent interventional cardiologist blinded to TEE results. Agreement between methods was evaluated.


RESULTS
Complete imaging data were available for analysis in 20 patients who, between 2002 and 2009, underwent transcatheter reduction in which the defect was successfully crossed. There was excellent agreement between procedural TEE and retrospective TEE review for PPL localization (100%; p < 0.0001) and between fluoroscopic and procedural TEE localization (90%; 95% confidence interval [CI]: 77% to 100%; p = 0.0003). In the 2 cases where there was disagreement, fluoroscopic PPL localization was adjacent to TEE localization.


CONCLUSIONS
The surgeon's-view time-clock method of localizing PPL using 2-dimensional TEE is highly reproducible and allows fluoroscopic localization using the same reference system with very good agreement.
Department of Medicine, Montreal Heart Institute/Université de Montréal, Montreal, Quebec, Canada.
Haïfa
H
Mahjoub
Stéphane
S
Noble
Réda
R
Ibrahim
Jeannot
J
Potvin
Eileen
E
O'Meara
Annie
A
Dore
François
F
Marcotte
Jacques
J
Crépeau
Raoul
R
Bonan
Asmaa
A
Mansour
Denis
D
Bouchard
Anique
A
Ducharme
Arsène J
AJ
Basmadjian
D000368:Aged; D006328:Cardiac Catheterization; D018618:Echocardiography, Doppler, Color / Q000592:standards; D017548:Echocardiography, Transesophageal / Q000592:standards*; D005260:Female; D005471:Fluoroscopy / Q000592:standards; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D015588:Observer Variation; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D011792:Quebec; D015641:Radiography, Interventional / Q000592:standards*; D012015:Reference Standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000592:standards*