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Paravalvular Leak Closure After Self-Expanding Transcatheter Aortic Valve Replacement Using a Steerable Sheath
Luke P Dawson1,2, Isabel Kim1, Christiane Haeffele1
1Division of Cardiovascular Medicine, Stanford Medicine, Stanford, California.
Summary
A paravalvular leak after transcatheter aortic valve replacement caused symptoms in an 82-year-old woman. A steerable sheath enabled successful closure using a vascular plug device.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Paravalvular leaks (PVLs) are a known complication following TAVR.
- Persistent symptoms like fatigue and dyspnea can occur due to significant PVLs.
Observation:
- An 82-year-old woman presented with persistent fatigue, exertional dyspnea, and dizziness.
- These symptoms were attributed to a paravalvular leak after a self-expanding TAVR procedure.
- The paravalvular leak was located within the structure of the self-expanding valve.
Findings:
- A novel approach was used to close the paravalvular leak.
- A steerable sheath was employed to precisely navigate the closure device.
- A vascular plug closure device was successfully deployed through the self-expanding valve to seal the leak.
Implications:
- This case demonstrates a successful technique for managing complex paravalvular leaks post-TAVR.
- The use of a steerable sheath and vascular plug offers a viable solution for challenging PVL closures.
- This minimally invasive approach may improve outcomes for patients experiencing PVL-related complications.
