3D transesophageal echo in percutaneous correction of paraprosthetic regurgitation.

About 210,000 valve replacement surgeries are performed annually worldwide. Paraprosthetic regurgitations are a complication that can happen, especially in mechanical prostheses and reoperations, reaching a prevalence of 10 to 15% in follow-up studies1. Surgical treatment remains the first choice, especially when there are significant symptoms and hemolysis. However, due to high perioperative mortality (6-14%)2,3, percutaneous techniques for correction of paraprosthetic regurgitation have been developed, although there are not yet specific occlusion devices. Real time three-dimensional transesophageal echocardiography (3DTEECHO) plays a fundamental role in the procedure since diagnosis, quantification of regurgitation, location and measurements of the regurgitant orifice, guiding in real-time the implantation of percutaneous prostheses. The initial experience of our service is four cases of occlusion of mitral paraprosthetic regurgitation percutaneously. Although we have not achieved complete resolution of regurgitation in three cases (two remained with moderate regurgitation and one with discreet regurgitation), it is worth noting that the procedures were conducted without complications and all patients improved functional class after implantation. In order to discuss the role of echocardiography this context, we describe a case where the complete occlusion of the paraprosthetic defect was achieved after implantation of the devices.