Percutaneous Closure of Paravalvular Leak from a Rocking Mitral Valve in a 74-Year-Old Man at High Surgical Risk

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Paravalvular leaks (PVLs) after prosthetic heart valve implantation are a significant clinical challenge.
• Surgical repair of PVLs can lead to recurrent dehiscence and suboptimal outcomes.
• Excessive prosthetic heart valve rocking is considered a contraindication for percutaneous PVL closure.

Observation:

• A symptomatic 74-year-old male presented with a rocking mitral valve and a substantial paravalvular leak due to dehiscence.
• The patient was deemed unsuitable for conventional surgical repair.
• Multimodal imaging was utilized to assess the complex valve dynamics and leak severity.

Findings:

• A novel percutaneous anchoring technique was employed to address both valve rocking and paravalvular leak.
• Multiple plugs were used in conjunction with imaging guidance for precise placement.
• Successful stabilization of the rocking mitral valve and closure of the paravalvular leak were achieved.

Implications:

• This case demonstrates the feasibility of percutaneous anchoring for managing complex prosthetic valve dehiscence with associated rocking.
• The technique offers a potentially less invasive alternative to surgery for high-risk patients.
• This approach may expand the indications for percutaneous interventions in prosthetic heart valve complications.