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. 2022 Apr 1;11(7):1978. doi: 10.3390/jcm11071978

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© 2022 by the authors.

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

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(A) Baseline 3D TEE color Doppler showing two round-shaped mitral PVLs with significant regurgitant jets located at 5 o’clock (3.2 mm) and 7 o’clock (3.6 mm) (a,b) in a female patient with a mitral bioprosthetic valve replacement; (c): successful implantation of a 3 mm-square twist PLD (red asterisk) at 5 o’clock; (d): fusion of real-time 2D TEE (Phillips Epiq7) and cardiac fluoroscopy imaging was obtained using EchoNavigator®-system (Philips Healthcare, Best, The Netherlands) with the fused image maintained demonstrating the location of the postero-laterally located (7 o’clock) mitral PVL (yellow circle) that was marked to aid the pathway of the guidewire (black arrow) crossing the leak, particularly in the case of a radiolucent bioprosthetic valve like in our patient. “*” refers to 3 mm-square twist PLD. (B) Intraprocedural navigation using fusion of 3D TEE and fluoroscopy with the fused image maintained helped the interventionalist to close successfully the second leak with a 5 mm-square twist PLD (black asterisk), improving the safety and the efficacy of this technically challenging procedure. PLD, Occlutech Paravalvular Leak Device ST, square twist, “*” refers to 5 mm-square twist PLD.

(A) Baseline 3D TEE color Doppler showing two round-shaped mitral PVLs with significant regurgitant jets located at 5 o’clock (3.2 mm) and 7 o’clock (3.6 mm) (a,b) in a female patient with a mitral bioprosthetic valve replacement; (c): successful implantation of a 3 mm-square twist PLD (red asterisk) at 5 o’clock; (d): fusion of real-time 2D TEE (Phillips Epiq7) and cardiac fluoroscopy imaging was obtained using EchoNavigator®-system (Philips Healthcare, Best, The Netherlands) with the fused image maintained demonstrating the location of the postero-laterally located (7 o’clock) mitral PVL (yellow circle) that was marked to aid the pathway of the guidewire (black arrow) crossing the leak, particularly in the case of a radiolucent bioprosthetic valve like in our patient. “*” refers to 3 mm-square twist PLD. (B) Intraprocedural navigation using fusion of 3D TEE and fluoroscopy with the fused image maintained helped the interventionalist to close successfully the second leak with a 5 mm-square twist PLD (black asterisk), improving the safety and the efficacy of this technically challenging procedure. PLD, Occlutech Paravalvular Leak Device ST, square twist, “*” refers to 5 mm-square twist PLD.