{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:47:47Z","timestamp":1780397267142,"version":"3.54.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2020YFC2008100"],"award-info":[{"award-number":["2020YFC2008100"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013149","name":"Science and Technology Innovation as a Whole Plan Projects of Shaanxi Province","doi-asserted-by":"publisher","award":["2016SF-225"],"award-info":[{"award-number":["2016SF-225"]}],"id":[{"id":"10.13039\/501100013149","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012659","name":"Foundation for Innovative Research Groups of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["S2020TD-034"],"award-info":[{"award-number":["S2020TD-034"]}],"id":[{"id":"10.13039\/501100012659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013149","name":"Science and Technology Innovation as a Whole Plan Projects of Shaanxi Province","doi-asserted-by":"publisher","award":["82000373"],"award-info":[{"award-number":["82000373"]}],"id":[{"id":"10.13039\/501100013149","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Closure of a percutaneous paravalvular leak (PVL) is a technically challenging procedure because of the specific anatomy postoperatively and the complex catheter techniques required. Transesophageal echocardiography (TEE) and three-dimensional (3D) printing might be helpful in identifying complex anatomical structures and the procedural design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The purpose of this study was to review our experiences with transcatheter closure of PVL guided by TEE and 3D (TEE&amp;amp;3D) printing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 166 patients with PVL after surgical valve replacement underwent transcatheter closure, from January 2015 through December 2020. Among these patients, 68 had preoperative guidance from TEE&amp;amp;3D printing. We reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up period was 36 (3\u201370) months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Acute procedural success was achieved in 154\/166 (92.8%) patients; of these, 64\/68 (94.1%) had TEE&amp;amp;3D guidance and 90\/98 (91.8%) had transthoracic echocardiography (TTE) guidance. No hospital deaths occurred. All patients having percutaneous procedures were given local anesthesia, while 13 patients having transapical procedures were given general anesthesia. Multiple approaches were used, including transfemoral, transapical, and transseptal <jats:italic>via<\/jats:italic> the arteriovenous loop. We also deployed multiple devices, including the Amplatzer Vascular Plug II (AVP II), the Amplatzer duct occluder II, the patent ductus arteriosus (PDA) occluder, and the Amplatzer muscular ventricular septal defect occluder. Those cases guided by TEE&amp;amp;3D printing had shorter procedural times compared with those guided by TTE [(61.2 \u00b1 23.4) vs. (105.7 \u00b1 53.9) min, <jats:italic>p<\/jats:italic> &amp;lt; 0.05]. The fluoroscopic time was also shorter for operations guided by TEE&amp;amp;3D printing compared with those guided by TTE alone [(18.5 \u00b1 11.4) vs. (27.3 \u00b1 5.6) min, <jats:italic>p<\/jats:italic> &amp;lt; 0.05]. The complications included recurrent hemolysis, residual regurgitation, acute renal insufficiency, and anemia. There was no significant difference in the incidence of complications between the 2 groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Transesophageal echocardiography and 3D printing show advantages compared with standalone TTE in guiding the transcatheter closure of PVL with shorter procedural and fluoroscopic times. This minimally invasive treatment could provide reliable outcomes in selected patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>[<jats:ext-link>www.ClinicalTrials.gov<\/jats:ext-link>], identifier [NCT02917980].<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.750896","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T04:40:07Z","timestamp":1653021607000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Transcatheter Closure of a Paravalvular Leak Guided by Transesophageal Echocardiography and Three-Dimensional Printing"],"prefix":"10.3389","volume":"9","author":[{"given":"Chennian","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengen","family":"Zhai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanlan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1136\/heartjnl-2014-306270","article-title":"Percutaneous repair of paravalvular prosthetic regurgitation: patient selection, techniques and outcomes.","volume":"101","author":"Sorajja","year":"2015","journal-title":"Heart."},{"key":"B2","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.jcin.2011.11.007","article-title":"Principles of percutaneous paravalvular leak closure.","volume":"5","author":"Rihal","year":"2012","journal-title":"JACC Cardiovasc Interv."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.4244\/EIJ-D-19-00517","article-title":"Midterm procedural and clinical outcomes of percutaneous paravalvular leak closure with the occlutech paravalvular leak device.","volume":"15","author":"Onorato","year":"2020","journal-title":"Eurointervention."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1016\/j.athoracsur.2015.03.104","article-title":"Paravalvular leak after mitral valve replacement: 20-Year follow-up.","volume":"100","author":"Hwang","year":"2015","journal-title":"Ann Thorac Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1007\/s00392-018-1290-7","article-title":"Interventional treatment of paravalvular regurgitation by plug implantation following prosthetic valve replacement: a single-center experience.","volume":"107","author":"Werner","year":"2018","journal-title":"Clin Res Cardiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.amjcard.2018.03.360","article-title":"Meta-analysis comparing transcatheter and surgical treatments of paravalvular leaks.","volume":"122","author":"Busu","year":"2018","journal-title":"Am J Cardiol."},{"key":"B7","first-page":"55","article-title":"Paravalvular regurgitation: clinical outcomes in surgical and percutaneous treatments. 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