Standardized Real-Time 3d Transesophageal Echocardiography Algorithm for Optimal Choice of the Transcatheter Closure Device for Mitral Paravalvular Leaks (Vale Pvl Registry)

Purpose: Transcatheter paravalvular leak closure (TPVLC) has become a well-established method of treatment for patients with PVL-related heart failure and hemolysis. Nonetheless, the method of optimal PVL sizing and subsequent device choice requires standardization. For this purpose, we developed a real-time three-dimensional transesophageal echocardiography (3D-RT TEE) algorithm. It has already proved clinically useful with results successfully translated into type, size, and number of occluding devices. Still, the intra- and inter-observer variability of measurements has not been investigated so far.

Methods: Three echocardiographers, with 3D-RT TEE clinical experience ranging from 1 to 8 years, analyzed recordings of 20 mitral PVLs according to our standardized protocol. PVL channel cross-sectional area (CSA), width and length were measured at the level of vena contracta. Each echocardiographer performed the measurements twice on different days, individually and blinded to other participants’ results.

Results: Measurements of PVL CSA, width and length showed intra- and interobserver agreement of 0.98, 0.93, 0.92 and 0.95, 0.88, 0.87, respectively.

Conclusions: Presented algorithm enables standardized utilization of 3D-RT TEE for adequate TPVLC device choice with low intra- and inter-observer variability.