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Paravalvular Leak Assessment: Challenges in Assessing Severity and Interventional Approaches
Elias J Fanous1, Roy B Mukku2, Pranali Dave3
1Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Current Cardiology Reports
|October 10, 2020
Summary
Paravalvular leaks (PVL) are a recognized complication of prosthetic heart valves, potentially causing heart failure. This review guides the evaluation and management of PVL, despite a lack of current guidelines.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Prosthetic valves are increasingly used for valvular heart disease (VHD) in aging populations.
- Paravalvular leaks (PVL) are a recognized complication with significant adverse consequences, including heart failure and hemolytic anemia.
- Current guidelines for PVL evaluation and management are lacking.
Purpose of the Study:
- To provide a cohesive review of existing literature on paravalvular leaks (PVL).
- To guide the evaluation and management of PVL in patients with prosthetic heart valves.
Main Methods:
- Comprehensive literature review of PVL diagnosis and treatment.
- Analysis of imaging modalities (echocardiography, CT, MRI) for PVL assessment.
- Review of surgical and transcatheter therapeutic options for PVL.
Main Results:
- Significant PVL occurs in 4-7.4% of valve replacements, posing challenges despite treatment advances.
- Improved imaging enhances understanding of PVL location, mechanism, and severity.
- Transcatheter interventions (plugs, valve-in-valve) show promising outcomes for select patients.
Conclusions:
- PVL remains a significant complication of prosthetic valves requiring better management strategies.
- Multimodality imaging is crucial for accurate PVL diagnosis and treatment planning.
- Transcatheter approaches offer effective treatment options for selected PVL cases.
Keywords:
Balloon post-dilation (BPD)Bioprosthetic valveParavalvular leak (PVL)Transcatheter aortic valve replacement (TAVR)Valve-in-valve (ViV)Vascular plug (VP)More Related Videos
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