Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and can result in potential arterial complications. Here, we aimed to assess the safety and feasibility of device closure of PmVSDs via the femoral vein approach under transesophageal echocardiography (TEE) guidance in children. From January 2014 to December 2017, a total of 46 PmVSD patients (mean age, 6.5 ± 2.3 years [range, 4.2–12.0 years]; mean body weight 22.1 ± 6.6 kg [range, 16.0–38.5 kg]; VSD diameter, 4.1 ± 0.6 mm [range, 3.2–5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy. The transcatheter occlusion procedure under TEE guidance was successful in 44 (95.7%) patients. Surgery was necessary in 2 (4.3%) patients. The procedure duration was 28.2 ± 8.7 min (range, 12.0–42.0 min). One patient had immediate post-operative trivial residual shunt and three patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 1 case was noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1–24 months follow-up. Percutaneous device closure of PmVSDs under TEE guidance solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision.

Percutaneous vertebroplasty is commonly used to treats vertebral fractures, tumors, and osteolytic vertebral metastases. However, cement leakage during the procedure can lead to severe complications, including cardiac perforation. This report presents a case of right atrial perforation and pulmonary embolism caused by cement leakage, emphasizing the clinical significance of these events and discussing the treatment strategy. A 57-year-old female was admitted to the hospital with a slipped lumbar vertebra and back pain, for which she underwent percutaneous vertebroplasty. On the 10th postoperative day, the patient suddenly developed chest tightness and shortness of breath, accompanied by a gradual decline in hemoglobin levels. After several imaging studies, a diagnosis of right atrial perforation caused by bone cement was confirmed. The patient subsequently underwent open cardiac foreign body removal and made a full recovery, with no residual cardiac dysfunction. This case highlights the rare but serious complication of right atrial perforation caused by bone cement leakage during percutaneous vertebroplasty. The report emphasizes the importance of early identification of bone cement-related complications. While conservative management may suffice for pulmonary embolism, urgent surgical treatment is required for cardiac cement embolism to prevent further complications.

Myocardial biopsy plays a critical role in the diagnosis of myocardial disorders, particularly in cases with undetermined etiology. This study was designed

To report on a patient who developed multiple perivalvular leaks (PVLs) after a mechanical mitral valve replacement, and how clinicians successfully used real-time three-dimensional transesophageal echocardiography combined with 3D printing to complete transapical perivalvular closure. Additionally, we reviewed the literature to explore the advantages and disadvantages of multimodal imaging for perivalvular leaks.The case is a 63-year-old female patient with a history of rheumatic heart disease underwent mitral mechanical valve replacement, tricuspid valvuloplasty, and left atrial folding four years ago. She presented with shortness of breath and TTE revealed two PVLs. Real-time 3D TEE combined with 3D printing technology was used to create a 3D model of the patient's heart, which allowed for precise identification of the PVLs. The transapical occlusion was successfully performed under the guidance of 3D TEE.The patient also showed good recovery during postoperative follow-up.The combination of 3D ultrasound and color mapping is advantageous in identifying and describing multiple PVLs. The use of 3D TEE combined with 3D printing technology provides a "double protection" in closure of PVLs, allowing for more accurate and precise placement of closure devices. Multimodal imaging plays a critical role in the management of PVLs, providing clinicians with essential information for successful treatment.

Accurate assessment of perivalvular leak (PVL) morphology following valve replacement remains a significant clinical challenge. Precise characterization of