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Updated: Oct 12, 2025

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Mitral valve paravalvular leaks: Comprehensive review of literature

Imran Karim Janmohamed1, Vaibhav Mishra2, Alexander Geragotellis3

  • 1Faculty of Medicine and Health, University of Leeds School of Medicine, Leeds, UK.

Journal of Cardiac Surgery
|November 25, 2021
PubMed
Abstract

Insights

Mitral paravalvular leaks (mPVL) can cause serious heart issues. Early diagnosis and multimodal imaging are key for effective management, with percutaneous closure emerging as a preferred treatment over surgery.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Mitral paravalvular leaks (mPVL) are a known complication of mitral valve prostheses.
  • While often asymptomatic, mPVL can lead to severe complications like heart failure and hemolysis.
  • A high index of clinical suspicion is crucial for timely diagnosis in symptomatic patients.

Purpose of the Study:

  • To review the pathogenesis, clinical presentation, diagnostic methods, imaging techniques, and treatment options for mitral paravalvular leaks.
  • To highlight the importance of multimodal imaging in managing mPVL.
  • To discuss the evolving landscape of treatment, including percutaneous interventions.

Main Methods:

  • Comprehensive literature search across major databases (PubMed, EMBASE, Cochrane, Google Scholar, Ovid).
  • Inclusion of search terms covering mPVL, various echocardiographic modalities (TTE, 2D/3D TEE), cardiac CT, CMR, intracardiac echo, and fluoroscopy.
  • Review of diagnostic and procedural planning tools.

Main Results:

  • Regular, comprehensive evaluation including history, physical exam, labs, and imaging is recommended for all mPVL patients.
  • Echocardiography is central to diagnosis, complemented by CMR, CT, and fluoroscopy for detailed characterization and planning.
  • Multimodal imaging is essential for guiding both diagnostic and therapeutic strategies.

Conclusions:

  • The incidence of mPVL is projected to rise with increased valve replacement procedures.
  • Advances in imaging and transcatheter devices are driving the adoption of percutaneous treatments.
  • Percutaneous closure is increasingly favored over traditional surgery due to lower risk and improved outcomes.
Keywords:
echocardiographymitral valveparavalvular leaktranscatheter closure

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