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Updated: May 18, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Paravalvular leaks: mechanisms, diagnosis and management
Eulogio García1, Jorge Sandoval, Leire Unzue
1Interventional Cardiology, Cardiac Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain. ejgarcia1@telefonica.net
Summary
Paravalvular leaks after valve surgery are common, especially mitral leaks. Percutaneous closure offers high success rates for aortic leaks but requires further device development for mitral leaks.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Paravalvular leaks (PVLs) are complications following surgical valve implantation.
- Understanding their incidence, causes, and management is crucial for patient outcomes.
Purpose of the Study:
- To review the incidence, etiology, and mechanisms of aortic and mitral PVLs.
- To assess diagnostic and therapeutic strategies for PVLs.
- To evaluate the outcomes of different treatment approaches.
Main Methods:
- Literature search and analysis of institutional experience.
- Utilized 2D/3D transesophageal echocardiography for diagnosis and guidance.
- Assessed hemolysis using specific blood markers (hemoglobin, hematocrit, LDH, haptoglobin).
Main Results:
- Transesophageal echocardiography is the primary diagnostic tool.
- Percutaneous closure of aortic PVLs has ~90% success with low complications.
- Mitral PVL closure success ranges from 75-90%, with ~10% 30-day complication rate and ~1% mortality.
Conclusions:
- PVLs have multifactorial causes, often linked to valvular ring anatomy.
- Mitral PVLs are thrice more common than aortic PVLs and increase with reoperation.
- Current percutaneous devices need further development for effective PVL treatment.
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