Left Main Obstruction From Paravalvular Leak Closure Device in Patient With Surgical Aortic Valve Replacement

Paravalvular leak (PVL) is a relatively rare complication associated with prosthetic valve replacement, which in some cases can lead to congestive heart failure or complications of hemolysis.

A 65-year-old man with prior surgical aortic valve replacement presented with symptoms of dyspnea, reduced left ventricular ejection fraction, and interval development of severe PVL.

PVL can be managed either surgically or percutaneously. Although transcatheter closure is less invasive, it can cause rare complications such as coronary obstruction from vascular plug devices. Through this case, we show how to effectively manage such complications with coronary stenting in a patient with a large aortic PVL and low left coronary ostia.

Coronary obstruction is a rare but serious complication of PVL closure device. It may be caused by device position or thrombus. Assessment requires multimodality imaging. Coronary stenting can effectively manage and prevent adverse events.