Real-time three-dimensional transesophageal echocardiography and three-dimensional printing: detection of multiple perivalvular leaks after mitral valve replacement-a case report and literature review.

BACKGROUND

Accurate assessment of perivalvular leak (PVL) morphology following valve replacement remains a significant clinical challenge. Precise characterization of PVL anatomy is essential, as different leak patterns require distinct management strategies. We report a case in which two complementary imaging modalities—real-time three-dimensional (RT-3D) transesophageal echocardiography (TEE) and three-dimensional (3D) printing technology—were successfully utilized to evaluate PVL morphology and guide the subsequent surgical approach. CASE PRESENTATION: A 63-year-old woman with a history of mechanical mitral valve replacement was found to have a PVL on follow-up transthoracic echocardiography (TTE), but the number and morphology could not be fully determined. Initial 3D printing based on cardiac computed tomography angiography (CTA) depicted only one defect; however, subsequent RT-3D TEE revealed two adjacent leaks. Based on TEE findings, the 3D printing parameters were adjusted, allowing visualization of both leaks. These imaging results informed a tailored interventional strategy, and transcatheter closure of the mitral PVLs was successfully performed via left ventricular apical access under real-time TEE guidance.

CONCLUSIONS

The synergistic integration of RT-3D TEE with color Doppler and 3D printing technology offers complementary strengths in the morphological assessment of complex or multiple PVLs, highlighting its potential clinical value in selected challenging cases.