title: Severe mitral paravalvular leakage: echo-morphologic description of 47 patients from real-time three-dimensional transesophageal echocardiography perspective.
abstract: OBJECTIVE
  Paravalvular leaks (PVLs) commonly occur in mitral prostheses. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) may provide invaluable information about complex 3D anatomy of mitral PVLs compared to two-dimensional (2D) TEE findings. We, herein, aimed to evaluate the detailed description of anatomical characteristics of severe mitral PVLs using RT-3D TEE.
  
  
  METHODS
  Patients with diagnosis of severe mitral PVLs were simultaneously examined with 2D transthoracic echocardiography (TTE), 2D TEE, and RT-3D TEE. 3D characteristics of PVLs (localization, number, size, shape, etc.) were recorded and compared to 2D findings. Results were also compared with surgical findings.
  
  
  RESULTS
  The study comprised 47 cases (3 bioprosthesis, 44 mechanical) with 61 severe mitral PVLs. The most common PVL localizations were anterolateral commissure, posteromedial commissures and posterolateral region. The mean PVL width measured by 2D TEE was 3.1±1.3 (range; 2-7) mm and the mean width of defect measured by 3D TEE was 3.1±1.1 (range; 2-7) mm (p=0.7). The mean length of defect measured by 3D TEE was 11.1±6.5 mm. The most common defect type was 'oval/round' shaped (n=29; 48%). There were also 19 'crescentic' (31%), 9 'slit like' (15%), and 2 tunnel-like shaped defects. In 22 patients, the site and dimension of the PVLs were all confirmed surgically.
  
  
  CONCLUSIONS
  RT-3D TEE permits detailed structural evaluation of the prosthesis and description of paravalvular leak morphology compared to 2D TEE. It may provide more accurate information to the clinician in decision making and may contribute to the success of the potential corrective procedures.
authors.affiliation: Clinic of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul-Turkey. m.ozangursoy@yahoo.com.
authors.forename: Ozan Mustafa
authors.initials: OM
authors.lastname: Gürsoy
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Astarcıoğlu
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.forename: Ahmet Cağrı
authors.initials: AC
authors.lastname: Aykan
authors.forename: Zübeyde
authors.initials: Z
authors.lastname: Bayram
authors.forename: Beytullah
authors.initials: B
authors.lastname: Cakal
authors.forename: Süleyman
authors.initials: S
authors.lastname: Karakoyun
authors.forename: Gökhan
authors.initials: G
authors.lastname: Kahveci
authors.forename: Nilüfer
authors.initials: N
authors.lastname: Ekşi Duran
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yıldız
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkan
mesh_terms: D003661:Decision Support Techniques; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D012720:Severity of Illness Index