The heart in our hands: pathway to a three-dimensional problem solution
Abstract
Percutaneous closure of paravalvular leaks (PVLs) after aortic valve replacement has emerged as an effective - and often first-line - choice for patients with significant paravalvular regurgitation requiring intervention. The defect can be approached via different routes (antegrade transseptal, retrograde transaortic, or transapical) based on the position of the valve, location of the defect and operator expertise. Several imaging modalities have been used, but predicting the number and size of devices to be implanted remains challenging.
Full text
Re is a
Po uguesa
de
Ca diologia
42
(2023)
675---676
www. e po ca diol.o g
Re is a
Po uguesa
de
Ca diologia
Po uguese
Jou nal
o
Ca diology
IMAGE
IN
CARDIOLOGY
The
hea
in
ou
hands:
Pa hway
o
a
h ee-dimensional
p oblem
solu ion
O
co ac¸ão
em
nossas
mãos
---
a
esoluc¸ão
de
um
p oblema
a a és
da
imp essão
3D
Tiago
Rod igues∗,
João
Sil a
Ma ques,
Faus o
J.
Pin o
Ca diology
Depa men ,
San a
Ma ia
Uni e si y
Hospi al,
CHULN,
CAML,
CCUL,
Facul y
o
Medicine,
Uni e si y
o
Lisbon,
Lisbon,
Po ugal
Recei ed
22
Feb ua y
2022;
accep ed
22
Ma ch
2022
A ailable
online
23
May
2023
Pe cu aneous
closu e
o
pa a al ula
leaks
(PVLs)
a e
ao -
ic
al e
eplacemen
has
eme ged
as
an
e ec i e
---
and
o en
fi s -line
--- choice
o
pa ien s
wi h
significan
pa -
a al ula
egu gi a ion
equi ing
in e en ion.
The
de ec
can
be
app oached
ia
di e en
ou es
(an eg ade
anssep-
al,
e og ade
ansao ic,
o
ansapical)
based
on
he
posi ion
o
he
al e,
loca ion
o
he
de ec
and
ope a o
expe ise.
Se e al
imaging
modali ies
ha e
been
used,
bu
p edic -
ing
he
numbe
and
size
o
de ices
o
be
implan ed
emains
challenging.
We
p esen
he
case
o
a
73-yea -old
man
admi ed
o
hea
ailu e
due
o
se e e
PVL
o
a
biop os he ic
ao -
ic
al e
(Figu e
1A).
A e
ca diac
compu ed
omog aphy
(Figu e
1B
and
C),
a
h ee-dimensional
(3D)
p in ed
model
o
∗Co esponding
au ho .
E-mail
add ess:
[email p o ec ed]
(T.
Rod igues).
he
hea
(Figu e
1D---F)
was
made
and
he
PVL
was
closed
in
a
pa ien -specific
simula ion
wi h
h ee
Ampla ze
Vascula
Plugs
(AVP)
(5-mm
AVP
III
14,
5-mm
AVP
III
10
and
5-mm
AVP
II).
The
p ocedu e
was
eplica ed
in
he
pa ien
wi hou
sig-
nifican
esidual
egu gi a ion
on
colo
3D
ansesophageal
echoca diog aphy
(Figu e
1G).
This
case
demons a es
ha
3D
p in ed
models
can
be
ex emely
use ul
o
de ailed
p ep ocedu al
planning
o
pe cu aneous
closu e
o
PVLs,
and
enable
bench- es ing
o
help
iden i y
he
loca ion
and
op imal
ype,
numbe ,
and
size
o
de ice(s)
o
be
used.
This
is
especially
use-
ul
in
di ficul
ana omies
and
in
cases
wi h
ailed
p e ious
a emp s.
Addi ionally,
3D
p in ing
enhances
doc o -pa ien
communica ion
and
ul ima ely
empowe s
pa ien
deci-
sions.
h ps://doi.o g/10.1016/j. epc.2022.03.011
0870-2551/©
2023
Published
by
Else ie
Espa˜
na,
S.L.U.
on
behal
o
Sociedade
Po uguesa
de
Ca diologia.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
T.
Rod igues,
J.
Sil a
Ma ques
and
F.J.
Pin o
Figu e
1
(A)
T ansesophageal
echoca diog aphy
showing
se e e
pa a al ula
leak
(PVL)
o
he
biop os he ic
ao ic
al e;
(B
and
C)
ca diac
compu ed
omog aphy
images
used
o
con-
s uc
he
h ee-dimensional
(3D)
p in ed
models
o
he
hea ;
Figu e
1
(Con inued)
Conflic s
o
in e es
The
au ho s
ha e
no
conflic s
o
in e es
o
decla e.
(D---F)
3D
p in ed
model
o
he
hea
wi h
simula ion
o
PVL
closu e
using
h ee
Ampla ze
Vascula
Plugs
(AVP)
(5-mm
AVP
III
14,
5-mm
AVP
III
10
and
5-mm
AVP
II);
(G)
fluo oscopy
image
o
he
p ocedu e.
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