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Percutaneous closure of a large aortic paravalvular leak using two duct occluder devices
Navaneetha Sasikumar1, Premsekar Rajasekar, Raghavan Suramanyan
1Department of Pediatric Cardiology, Frontier Lifeline Hospital, R-30/C, Ambattur Industrial Estate Road, Mogappair, Chennai 600101, Tamil Nadu, India.
Insights
Trans-catheter closure using two smaller devices effectively treated severe aortic paravalvular leak in a high-risk patient. This approach achieved near-complete leak abolition and symptom resolution at three months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Severe aortic paravalvular leak presents a significant clinical challenge, especially in patients with multiple prior cardiac surgeries and comorbidities.
- Trans-catheter interventions offer a less invasive alternative to repeat open-heart surgery for managing complex paravalvular leaks.
Observation:
- A 21-year-old male with severe aortic paravalvular leak, post three cardiac surgeries and chronic kidney disease, was considered high-risk for a fourth surgery.
- Initial trans-catheter device deployment resulted in a significant residual leak, necessitating a modified approach.
Findings:
- A tandem deployment of two smaller duct occluder devices, accessed via two arterial routes, successfully sealed the paravalvular leak.
- Post-procedure, there was near-complete resolution of the leak, and the patient remained asymptomatic at three-month follow-up.
Implications:
- The use of multiple smaller devices may be superior to a single larger device for addressing larger paravalvular leaks.
- This case highlights technical considerations for tandem device deployment in complex paravalvular leak closure.
- Trans-catheter closure with multiple devices provides a viable therapeutic option for high-risk patients with severe aortic paravalvular leaks.
Abstract:
A 21-year-old male presented with severe aortic paravalvular leak. He had undergone three cardiac surgeries and also had chronic kidney disease. It was decided for a trans-catheter closure owing to the risks of a fourth surgery and co-morbidity. The device was sized based on angiogram, balloon sizing and two dimensional transesophageal echo. There was significant residual leak after deployment of first device. Hence the defect was re-crossed and two duct occluder devices were positioned across the leak from two arterial access. After confirming position and satisfactory reduction in paravalvular leak, the devices were released in tandem. There was near abolition of leak. The patient is asymptomatic at three months follow up. Larger paravalvular leaks are better addressed with two devices of smaller size rather than a single large device. Technical considerations while deploying multiple devices are discussed.
