Transcatheter mitral valve interventions (TMVI) have established as an alternative to surgery in selected cases. Transesophageal echocardiography is crucial to perform detailed imaging during procedures. Different photo-realistic rendering views (Philips, Andover, Massachusetts) have developed: transillumination, tissue-transparency (TT), and both with 3-dimensional (3D) color. Some TMVI examples employing this technology are shown: edge-to-edge repair, valve-invalve replacement, paravalvular leak closure, and transseptal puncture and residual interatrial septal shunt assessment. Videos 1 to 4 show same examples. Placing the light source behind soft tissues can be valuable to assess them by transillumination (MV leaflets; interatrial septum) or just to improve 3D perception with slight changes in light angle. On the other hand, tissuetransparency may be more useful when a residual regurgitant jet needs an origin and path assessment, or to increase border delineation over tissues or residual defects. To the best of our knowledge, this is the first report comparing different photo-realistic renders during miscellaneous TMVI. New 3D realistic renders with advance capabilities may be crucial in challenging scenarios, especially to define lesions to treat and residual regurgitation mechanisms.
Keywords: 3-dimensional transesophageal echocardiography; photo-realistic imaging; structural heart intervention; transcatheter mitral valve intervention

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