Limitations of 3D TEE include artifacts of ultrasound imaging (eg, dropout, acoustic shadowing, rever- beration artifacts) and reduced temporal and spatial Transcatheter closure using intracardiac echocardiography guidance is possible and allevi- ates the need for conscious sedation or anesthesia but allows only 2D and color Doppler imaging.9 11.9.2. Medical Therapy Medical therapy for prosthetic valve regurgitation is ap- propriate in asymptomatic patients or when the cause of regurgitation is valve thrombosis (see Sections 11.6 and 11.8) or prosthetic valve endocarditis (see Section 12.3), although further intervention may ultimately be needed in many of these patients. Some patients tolerate asymp- tomatic prosthetic valve regurgitation for many years, sim- ilar to patients with native valve regurgitation. However, there may be patients who develop rapid progression of the severity of bioprosthetic valve regurgitation because of leaflet degeneration. In patients with hemolytic ane- mia attributable to paravalvular regurgitation, medical management with folic acid and iron supplementation or periodic transfusion may be possible when the anemia is not severe, with intervention reserved for patients with symptomatic intractable anemia (see Section 11.8.3). Recommendations for Intervention Referenced studies that support the recommendations are summarized in Online Data Supplement 41. 