Use of Real Time Three-Dimensional Transesophageal Echocardiography in Intracardiac Catheter Based Interventions

  • Gila Perk
    Correspondence
    Reprint requests: Gila Perk, MD, New York University School of Medicine, Non-Invasive Cardiology, 550 First Avenue, TH-2, HW-228, New York, NY 10016.
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Roberto M. Lang
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Miguel Angel Garcia-Fernandez
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Joe Lodato
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Lissa Sugeng
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • John Lopez
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Brad P. Knight
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • David Messika-Zeitoun
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Sanjiv Shah
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • James Slater
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Eric Brochet
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Mathew Varkey
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Ziyad Hijazi
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Nino Marino
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Carlos Ruiz
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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  • Itzhak Kronzon
    Affiliations
    From New York University School of Medicine, New York, New York (G.P., J.S., M.V., I.K.); the University of Chicago Medical Center, Chicago, Illinois (R.M.L., J. Lodato, L.S., J. Lopez, B.P.K., S.S., Z.H.); Hospital General Universitario, Gregorio Maranon, Madrid, Spain (M.A.G.-F.); Bichat Hospital, Paris, France (D.M.-Z., E.B.); and the Interventional Cardiology Department, Lenox Hill Heart and Vascular Institute, New York, New York (C.R, N.M.)
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      Background

      Real-time three-dimensional (RT3D) echocardiography is a recently developed technique that is being increasingly used in echocardiography laboratories. Over the past several years, improvements in transducer technologies have allowed development of a full matrix-array transducer that allows acquisition of pyramidal-shaped data sets. These data sets can be processed online and offline to allow accurate evaluation of cardiac structures, volumes, and mass. More recently, a transesophageal transducer with RT3D capabilities has been developed. This allows acquisition of high-quality RT3D images on transesophageal echocardiography (TEE). Percutaneous catheter-based procedures have gained growing acceptance in the cardiac procedural armamentarium. Advances in technology and technical skills allow increasingly complex procedures to be performed using a catheter-based approach, thus obviating the need for open-heart surgery.

      Methods

      The authors used RT3D TEE to guide 72 catheter-based cardiac interventions. The procedures included the occlusion of atrial septal defects or patent foramen ovales (n = 25), percutaneous mitral valve repair (e-valve clipping; n = 3), mitral balloon valvuloplasty for mitral stenosis (n = 10), left atrial appendage obliteration (n = 11), left atrial or pulmonary vein ablation for atrial fibrillation (n = 5), percutaneous closures of prosthetic valve dehiscence (n = 10), percutaneous aortic valve replacement (n = 6), and percutaneous closures of ventricular septal defects (n = 2). In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered.

      Results

      The main advantages found for the use RT3D TEE during catheter-based interventions were (1) the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and (2) the ability to ability to demonstrate certain structures in an “en face” view, which is not offered by any other currently available real-time imaging technique, enabling appreciation of the exact nature of the lesion that is undergoing intervention.

      Conclusion

      RT3D TEE is a powerful new imaging tool that may become the technique of choice and the standard of care for guidance of selected percutaneous catheter-based procedures.

      Keywords

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      References

        • Sugeng L.
        • Weinert L.
        • Lang R.M.
        Left ventricular assessment using real time three dimensional echocardiography.
        Heart. 2003; 89: 29-36
        • Mor Avi V.
        • Sugeng L.
        • Weinert L.
        • MacEneaney P.
        • Caiani E.G.
        • Koch R.
        • et al.
        Fast measurement of left ventricular mass with real-time three-dimensional echocardiography. Comparison with magnetic resonance imaging.
        Circulation. 2004; 110: 1814-1818
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • et al.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Mor-Avi V.
        • Jenkins C.
        • Kuhl H.P.
        • Nesser H.J.
        • Marwick T.
        • Franke A.
        • et al.
        Real-time 3-dimensional echocardiographic quantification of left ventricular volumes.
        J Am Coll Cardiol Cardiovasc Imaging. 2008; 1: 413-423
        • Hung J.S.
        • Chern M.S.
        • Wu J.J.
        • Fu M.
        • Yeh K.H.
        • Wu Y.C.
        • et al.
        Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy.
        Am J Cardiol. 1991; 67: 854-862
        • Arora R.
        • Kalra G.S.
        • Singh S.
        • Mukhopadhyay S.
        • Kumar A.
        • Mohan J.C.
        • et al.
        Percutaneous transvenous mitral commissurotomy: immediate and long-term follow-up results.
        Catheter Cardiovasc Interv. 2002; 55: 450-456
        • Masura J.
        • Gavora P.
        • Pondar T.
        Long term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders.
        J Am Coll Cardiol. 2005; 45: 505-507
        • Balbi M.
        • Casalino L.
        • Gnecco G.
        • Bezante G.P.
        • Pongiglione G.
        • Marasini M.
        • et al.
        Percutaneous closure of patent foramen ovale in patients with presumed paradoxical embolism: periprocedural results and midterm risk of recurrent neurologic events.
        Am Heart J. 2008; 56: 356-360
        • Luermans J.G.
        • Post M.C.
        • Schräder R.
        • Sluysmans T.
        • Vydt T.
        • Vermeersch P.
        • et al.
        Outcome after percutaneous closure of a patent foramen ovale using the Intrasept device: a multi-centre study.
        Catheter Cardiovasc Interv. 2008; 71: 822-828
        • Sievert H.
        • Lesh M.D.
        • Trepels T.
        • Omran H.
        • Bartorelli A.
        • Della Bella P.
        • et al.
        Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience.
        Circulation. 2002; 105: 1887-1889
        • Hung J.S.
        • Fu M.
        • Yeh K.H.
        • Wu C.J.
        • Wong P.
        Usefulness of intracardiac echocardiography in complex transseptal catheterization during percutaneous transvenous mitral commissurotomy.
        Mayo Clin Proc. 1996; 71: 134-140
        • Zanchetta M.
        On-line intracardiac echocardiography alone for Amplatzer Septal Occluder selection and device deployment in adult patients with atrial septal defect.
        Int J Cardiol. 2004; 95: 61-68
        • Kronzon I.
        • Tunick P.A.
        • Schwinger M.E.
        • Slater J.
        • Glassman E.
        Transesophageal echocardiography during percutaneous mitral valvuloplasty.
        J Am Soc Echocardiogr. 1989; 2: 380-385
        • Kronzon I.
        • Tunick P.A.
        • Glassman E.
        • Slater J.
        • Schwinger M.
        • Freedberg R.S.
        Transesophageal echocardiography to detect atrial clots in candidates for percutaneous transseptal mitral balloon valvuloplasty.
        J Am Coll Cardiol. 1990; 16: 1320-1322
        • Vilacosta I.
        • Iturralde E.
        • San Román J.A.
        • Gómez-Recio M.
        • Romero C.
        • Jiménez J.
        • et al.
        Transesophageal echocardiographic monitoring of percutaneous mitral balloon valvulotomy.
        Am J Cardiol. 1992; 70: 1040-1044
        • Goldstein S.A.
        • Campbell A.
        • Mintz G.S.
        • Pichard A.
        • Leon M.
        • Lindsay Jr., J.
        Feasibility of on-line transesophageal echocardiography during balloon mitral valvulotomy: experience with 93 patients.
        J Heart Valve Dis. 1994; 3: 136-148
        • Applebaum R.M.
        • Kasliwal R.R.
        • Kanojia A.
        • Seth A.
        • Bhandari S.
        • Trehan N.
        • et al.
        Utility of three-dimensional echocardiography during balloon mitral valvuloplasty.
        J Am Coll Cardiol. 1998; 32: 1405-1409
        • Mazic U.
        • Gavora P.
        • Masura J.
        The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder.
        Am Heart J. 2001; 142: 482-488
        • Podnar T.
        • Martanovic P.
        • Gavora P.
        • Masura J.
        Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluders.
        Catheter Cardiovasc Interv. 2001; 53: 386-391
        • Acar P.
        • Saliba Z.
        • Bonhoeffer P.
        • Aggoun Y.
        • Bonnet D.
        • Sidi D.
        • et al.
        Influence of atrial septal defect anatomy in patient selection and assessment of closure with the Cardioseal device; a three-dimensional transoesophageal echocardiographic reconstruction.
        Eur Heart J. 2000; 21: 573-581
        • Feldman T.
        • Wasserman H.S.
        • Herrmann H.C.
        • Gray W.
        • Block P.C.
        • Whitlow P.
        • et al.
        Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST Phase I Clinical Trial.
        J Am Coll Cardiol. 2005; 46: 2134-2140
        • Herrmann H.C.
        • Rohatgi S.
        • Wasserman H.S.
        • Block P.
        • Gray W.
        • Hamilton A.
        • et al.
        Mitral valve hemodynamic effects of percutaneous edge-to-edge repair with the MitraClip device for mitral regurgitation.
        Catheter Cardiovasc Interv. 2006; 68: 821-828
        • Sugeng L.
        • Shernan S.K.
        • Weinert L.
        • Shook D.
        • Raman J.
        • Jeevanandam V.
        • et al.
        Real-time three-dimensional transesophageal echocardiography in valve disease: comparison with surgical findings and evaluation of prosthetic valves.
        J Am Soc Echocardiogr. 2008; 21: 1347-1354
        • Dean L.S.
        • Mickel M.
        • Bonan R.
        • Holmes Jr., D.R.
        • O'Neill W.W.
        • Palacios I.F.
        • et al.
        Four-year follow-up of patients undergoing percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry.
        J Am Coll Cardiol. 1996; 28: 1452-1457
        • Hernandez R.
        • Banuelos C.
        • Alfonso F.
        • Goicolea J.
        • Fernandez-Ortiz A.
        • Escaned J.
        • et al.
        Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon.
        Circulation. 1999; 99: 1580-1586
        • Fawzy M.E.
        • Mimish L.
        • Sivanandam V.
        • Lingamanaicker J.
        • Patel A.
        • Khan B.
        • et al.
        Immediate and long-term effect of mitral balloon valvotomy on severe pulmonary hypertension in patients with mitral stenosis.
        Am Heart J. 1996; 131: 89-93
        • Sugeng L.
        • Coon P.
        • Weinert L.
        • Jolly N.
        • Lammertin G.
        • Bednarz J.E.
        • et al.
        Use of real-time 3-dimensional transthoracic echocardiography in the evaluation of mitral valve disease.
        J Am Soc Echocardiogr. 2006; 19: 413-421
        • Grewal J.
        • Mankad S.
        • Freeman W.K.
        • Click R.L.
        • Suri R.M.
        • Abel M.D.
        • et al.
        Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease.
        J Am Soc Echocardiogr. 2009; 22: 34-41
        • Lange A.
        • Palka P.
        • Donnelly J.
        • Burstow D.
        Quantification of mitral regurgitation orifice area by 3-dimensional echocardiography: comparison with effective regurgitant orifice area by PISA method and proximal regurgitant jet diameter.
        Int J Cardiol. 2002; 86: 87-98
        • Sugeng L.
        • Weinert L.
        • Lang R.M.
        Real-time 3-dimensional color Doppler flow of mitral and tricuspid regurgitation: feasibility and initial quantitative comparison with 2-dimensional methods.
        J Am Soc Echocardiogr. 2007; 20: 1050-1057
        • Breburda C.S.
        • Griffin B.P.
        • Pu M.
        • Rodriguez L.
        • Cosgrove III, D.M.
        • Thomas J.D.
        Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence.
        J Am Coll Cardiol. 1998; 32: 432-437
        • García-Fernández M.A.
        • Pérez-David E.
        • Quiles J.
        • Peralta J.
        • García-Rojas I.
        • Bermejo J.
        • et al.
        Role of left atrial appendage obliteration in stroke reduction in patients with mitral valve prosthesis: a transesophageal echocardiographic study.
        J Am Coll Cardiol. 2003; 42: 1253-1258
        • Crystal E.
        • Lamy A.
        • Connolly S.J.
        • Kleine P.
        • Hohnloser S.H.
        • Semelhago L.
        • et al.
        Left Atrial Appendage Occlusion Study. Left Atrial Appendage Occlusion Study (LAAOS): a randomized clinical trial of left atrial appendage occlusion during routine coronary artery bypass graft surgery for long-term stroke prevention.
        Am Heart J. 2003; 145: 174-178
        • Blackshear J.L.
        • Johnson W.D.
        • Odell J.A.
        • Baker V.S.
        • Howard M.
        • Pearce L.
        • et al.
        Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation.
        J Am Coll Cardiol. 2003; 42: 1249-1252
        • Sick P.B.
        • Schuler G.
        • Hauptmann K.E.
        • Grube E.
        • Yakubov S.
        • Turi Z.G.
        • et al.
        Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation.
        J Am Coll Cardiol. 2007; 49: 1490-1495
        • Möbius-Winkler S.
        • Schuler G.C.
        • Sick P.B.
        Interventional treatments for stroke prevention in atrial fibrillation with emphasis upon the WATCHMAN device.
        Curr Opin Neurol. 2008; 21: 64-69
        • Hanna I.R.
        • Kolm P.
        • Martin R.
        • Reisman M.
        • Gray W.
        • Block P.C.
        Left atrial structure and function after percutaneous left atrial appendage transcatheter occlusion (PLAATO): six-month echocardiographic follow-up.
        J Am Coll Cardiol. 2004; 43: 1868-1872
        • Ostermayer S.H.
        • Reisman M.
        • Kramer P.H.
        • Matthews R.V.
        • Gray W.A.
        • Block P.C.
        • et al.
        Percutaneous left atrial appendage transcatheter occlusion (PLAATO system) to prevent stroke in high-risk patients with non-rheumatic atrial fibrillation: results from the international multi-center feasibility trials.
        J Am Coll Cardiol. 2005; 46: 9-14
        • Pappone C.
        • Rosanio S.
        • Oreto G.
        • Tocchi M.
        • Gugliotta F.
        • Vicedomini G.
        • et al.
        Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.
        Circulation. 2000; 102: 2619-2628
        • Oral H.
        • Knight B.P.
        • Tada H.
        • Ozaydin M.
        • Chugh A.
        • Hassan S.
        • et al.
        Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation.
        Circulation. 2002; 105: 1077-1081
        • Cappato R.
        • Calkins H.
        • Chen S.A.
        • Davies W.
        • Iesaka Y.
        • Kalman J.
        • et al.
        Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.
        Circulation. 2005; 111: 1100-1105
        • Kort H.W.
        • Sharkey A.M.
        • Balzer D.T.
        Novel use of the Amplatzer duct occluder to close perivalvar leak involving a prosthetic mitral valve.
        Catheter Cardiovasc Interv. 2004; 61: 548-551
        • Sorajja P.
        • Cabalka A.K.
        • Hagler D.J.
        • Reeder G.S.
        • Chandrasekaran K.
        • Cetta F.
        • et al.
        Successful percutaneous repair of perivalvular prosthetic regurgitation.
        Catheter Cardiovasc Interv. 2007; 70: 815-823
        • Lasorda D.M.
        • Mohsin J.C.
        Percutaneous closure of perivalvular mitral regurgitation with an Amplatzer occluder device in a patient with both prosthetic mitral and aortic valves.
        J Interv Cardiol. 2008; 21: 190-195
        • Nikolic A.
        • Schranz D.
        • Hristov N.
        • Mitrev Z.
        Amplatzer occlusion of paravalvular leak of mitral mechanical prosthesis following a reoperation for trombosed mitral mechanical prosthesis.
        Interact Cardiovasc Thorac Surg. 2008; 7: 941-942
        • Kim M.S.
        • Casserly I.P.
        • Garcia J.A.
        • Klein A.J.
        • Salcedo E.E.
        • Carroll J.D.
        Percutaneous transcatheter closure of prosthetic mitral paravalvular leaks: are we there yet?.
        J Am Coll Cardiol Intv. 2009; 2: 81-90
      1. Halpern DG, Perk G, Ruiz C, Marino N, Kronzon I. Percutaneous closure of a post-myocardial infarction ventricular septal defect guided by real-time three-dimensional echocardiography. Eur J Echocardiogr. In press.

        • Mullasari A.S.
        • Umesan C.V.
        • Krishnan U.
        • Srinivasan S.
        • Rvikumar M.
        • Raghuraman H.
        Transcatheter closure of post-myocardial infarction ventricular septal defect with Amplatzer septal occluder.
        Catheter Cardiovasc Interv. 2001; 54: 484-487
        • Holzer R.
        • Balzer D.
        • Amin Z.
        • Ruiz C.
        • Feinstein J.
        • Bass J.
        • et al.
        Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: results of a U.S. registry.
        Catheter Cardiovasc Interv. 2004; 61: 196-201
        • Balzer J.
        • Kuhl H.
        • Rassaf T.
        • Hoffman R.
        • Schauerte P.
        • Kelm M.
        • et al.
        Real-time transesophageal three-dimensional echocardiography for guidance of percutaneous cardiac interventions: first experience.
        Clin Res Cardiol. 2008; 97: 565-574