EchoNavigator virtual marker and Agilis NxT steerable introducer facilitate transseptal transcatheter closure of mitral paravalvular leak

Figure 1 EchoNavigator virtual marker and fusion imaging for transcatheter closure of paravalvular leak. A: Significant mitral paravalvular leak (PVL) was seen in transesophageal echocardiography (TEE 0 degrees); B: The PVL location at the X-plane views of TEE was marked to generate marker 1 on the fluoroscopic screen; C: A suitable point for transseptal puncture was made under the guidance of TEE; D: The curvature of the Agilis NxT steerable introducer was adjusted for better orientation; E: The PVL defect was crossed with a 0.035-inch guidewire supported by the telescoping system of a 6 Fr MP guide catheter and JR4 diagnostic catheter; F: Three-dimensional TEE showed the first Amplatzer Vascular Plug II (AVP II 12 mm); G: The second AVP II (10 mm) was deployed without releasing the first AVP II; H: The second AVP II (10 mm) was released first; I: Color Doppler mode of the TEE showed only mild residual PVL; J: Three-dimensional TEE showed that the 1st AVP II (12 mm) had been released; K: Final position of the two AVP II (blue arrow heads).