Percutaneous closure of a postero-medial mitral paravalvular leak: the triple telescopic system

Paravalvular leaks (PVLs) still remain as a serious complication of heart valve surgery. The reported incidence of PVL is ∼ 3-12.5% and most of them become clinically manifest as worsening heart failure, hemolysis, and arrhythmias within the first 6 months. Surgical intervention is recommended for symptomatic patients, but high-operative risk associated with the repeat procedures frequently prohibits the redo surgery for the older patients with multiple severe comorbidities. In view of the limitations of surgery, percutaneous closure techniques have been applied to PVLs with considerable achievement. However, the technique is still challenging due to the lack of specifically engineered instruments for the procedure and requires considerable operator expertise. In this case report, we presented a case of posteromedial mitral PVL, which was successfully closed using an innovative telescopic catheter system involving three different catheters.