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Multiple Mitral Paravalvular Leak Closure With VSD Occluder in a High Surgical Risk Patient
Shubham Mandhare1, Hemant Kokane1, Niraj Pawar1
1Department of Cardiology, Byramjee Jeejeebhoy Government Medical College & Sassoon General Hospital, Pune, India.
Background:
Mitral paravalvular leak (PVL) is a common complication after surgical mitral valve replacement, often causing symptomatic congestive cardiac failure. When transcatheter closure is planned, transesophageal echocardiography is essential for guiding percutaneous device closure.
Case Summary:
A 21-year-old woman with rheumatic heart disease and prior metallic mitral valve replacement presented with congestive cardiac failure. Transesophageal echocardiography revealed mitral paravalvular leaks and low ejection fraction. Considering her high surgical risk, the heart team opted for percutaneous PVL closure.
Discussion:
Mitral PVL after surgical mitral valve replacement can occur due to valve suture dehiscence. To our knowledge, we report the first case of multiple serpiginous mitral PVLs successfully closed in a single sitting, using 2 KONAR-MF VSD occluder devices, in a high surgical risk patient. The case highlights the flexibility and conformability of the KONAR-MF VSD occluder device, enhanced deliverability using a smaller sheath, and occlusive fabric promoting improved sealing. Tailored transcatheter closure can produce successful outcomes while minimizing the risk profile, in complex situations.
Take-Home Message:
Transcatheter closure of mitral PVLs with the KONAR-MF VSD occluder device is a safe and effective alternative to redo surgery in high surgical risk patients, providing symptomatic relief and improved cardiac function.
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