[Transcatheter closure of paraprosthetic valve leaks post surgical valve replacements]

To evaluate the feasibility and efficacy of transcatheter closure of paravalvular leak (PVL) with Chinese-made occluder.

Five PVL patients were involved in this study, 2 out of the 5 patients underwent aortic mechanical valve replacements, 2 underwent mitral bioprosthetic valve replacements, and the remaining 1 underwent double mechanical valve replacement.Left ventricular end diastolic diameter, left atrial diameter and the systolic pulmonary artery pressure were assessed by echocardiography before and post the procedure.

Complete occlusion without residual regurgitation was achieved in 2 patients with aortic PVL, for the 3 patients with mitral PVL, there was only tiny or mild mitral paraprosthetic leak remained post closure procedure. Cardiac perforation and pericardium tamponade occurred in 1 patient with aortic PVL during interventional closure and the patient recovered post emergent pericardiocentesis. Transient severe hemolysis and hemoglobinuria occurred in 3 patients with mitral PVL post closure procedure and they recovered after 1 to 3 weeks conservative therapy. During 3 months follow up, left ventricular end diastolic diameter [(52.2 ± 6.8) mm vs. (61.1 ± 7.2) mm, P < 0.05], the systolic pulmonary artery pressure [(40.0 ± 5.4) mm Hg (1 mm Hg = 0.133 kPa) vs. (57.0 ± 3.6) mm Hg, P < 0.05] and left atrial diameter of mitral PVL patient [(49.0 ± 4.3) mm vs. (56.0 ± 6.3) mm, P < 0.05] were significantly reduced compared to before closure procedure.

Percutaneous or transapical left ventricular access closure of PVL is feasible, effective and relative safe in selected patients.