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Paravalvular Leak
Fatima Qamar1, Rowa H Attar1, Faisal Nabi1
1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US.
Methodist Debakey Cardiovascular Journal
|April 18, 2022
Summary
Paravalvular leaks (PVL) are a complication of prosthetic valve replacement. This case demonstrates successful closure of a posterior mitral PVL using ventricular septal defect occluders.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Imaging
Background:
- Paravalvular leaks (PVL) remain a significant challenge in prosthetic valve disease management.
- PVL arise from surgical ring dehiscence, with the posterior mitral annulus being particularly susceptible.
- Risk factors include mitral annular calcification, endocarditis, steroid use, and continuous suturing.
Observation:
- A 70-year-old male presented with pulmonary edema and a dehiscence of his bioprosthetic mitral valve.
- Echocardiography revealed a large posterior PVL, depressed biventricular function, tricuspid regurgitation, and pulmonary hypertension.
- Transesophageal imaging confirmed significant posterior PVL with prosthetic valve dehiscence.
Findings:
- The paravalvular leak was successfully closed using two 18-mm Amplatzer ventricular septal defect occluders.
- The procedure resulted in excellent outcomes with only trace residual mitral regurgitation.
Implications:
- Percutaneous closure of paravalvular leaks is a viable treatment option.
- Ventricular septal defect occluders can be effectively used for mitral PVL closure.
- This approach offers a less invasive alternative for managing PVL complications.
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