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Internal Jugular Approach for Percutaneous Mitral Paravalvular Leak Closure in a Patient With Interrupted Inferior
Ali J Ebrahimi1, Mustafa Alkhawam1, Mustafa I Ahmed1
1Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Structural Heart : the Journal of the Heart Team
|October 15, 2025
Summary
This case study demonstrates a novel approach for treating severe mitral paravalvular leak (PVL) in a patient with complex venous anatomy. The right internal jugular vein access enabled successful transcatheter closure, offering a viable alternative when standard methods fail.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Severe mitral paravalvular leak (PVL) poses a significant challenge, particularly in patients with complex venous anatomy.
- Previous mitral valve surgery and interrupted inferior vena cava complicated standard treatment approaches.
Purpose of the Study:
- To describe a successful transcatheter closure of mitral PVL using an alternative venous access route.
- To evaluate the feasibility and efficacy of the right internal jugular vein approach for PVL treatment in complex cases.
Main Methods:
- A 48-year-old male with severe anteroseptal mitral PVL underwent a transcatheter procedure.
- Transseptal puncture was performed via the right internal jugular vein.
- Five Amplatzer Vascular Plug II devices were deployed for PVL closure under echocardiography and fluoroscopic guidance.
Main Results:
- Successful closure of the mitral paravalvular leak was achieved.
- Reduced mitral regurgitation and preserved native valve function were confirmed post-procedure.
- The right internal jugular vein approach proved effective in a challenging anatomical scenario.
Conclusions:
- The right internal jugular vein approach is a feasible and advantageous alternative for transcatheter mitral PVL closure in patients with difficult venous anatomy.
- This technique expands treatment options for complex cardiovascular conditions.
- Successful device closure highlights advancements in interventional cardiology for structural heart disease.
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