TEE is considered to be an integral part of transcatheter closure of paravalvular regurgitation and has a role in the selection of appropriate patients, facilitation of the procedure and assessment of the results (Table 2). When the antegrade approach is used, TEE may be used to guide the transseptal puncture. It can help guide the passage of the guidewire and catheter through the defect (Figure 20 B). Real-time 3D TEE has been shown to be particularly helpful in this regard (Figure 22B and Figure 25).

It should be ensured that the occluder does not impede proper opening and closing of the prosthetic leaflets/discs(Figure 26) and the occluder device is not released until proper device seating and prosthetic valve function are assured.

After the release of the device, TEE is performed to assess residual paravalvular regurgitation, which is not uncommon after the procedure. (Figure 27 D).

If the residual regurgitation is severe, placement of additional devices can be considered (Figure 28).