Late Migration of a Paravalvular Leak Closure Device

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Paravalvular leak (PVL) is a significant complication following surgical valve replacement, particularly in elderly, multimorbid patients.
• Surgical repair is often too risky, leading to the development of percutaneous PVL closure as a safer alternative.
• Current generic vascular closure devices used for PVL closure may lead to complications like residual regurgitation or device displacement.

Observation:

• A 70-year-old male with rheumatic heart disease and multiple prior valve replacements presented with heart failure due to paravalvular mitral regurgitation.
• Initial percutaneous PVL closure successfully reduced the leak.
• Thirty days later, the patient developed cardiogenic shock due to device displacement and severe mitral regurgitation.

Findings:

• The displaced closure device impinged on the mitral prosthesis, causing torrential regurgitation.
• Percutaneous retrieval of the device and subsequent closure with Amplatzer Vascular Plug III devices were performed due to prohibitive surgical risk.
• The patient remained asymptomatic at six-month follow-up.

Implications:

• Percutaneous PVL closure is an effective strategy for patients with high surgical risk.
• Late closure device displacement is a rare but potentially fatal complication.
• Percutaneous management of device displacement is feasible, even in critically ill patients.