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Published on: December 23, 2022
Transcatheter Paravalvular Leak Closure Using Valve Frame Access
Chloe Kharsa1, Mangesh Kritya1, Karl Abou Zeid1
1Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
Objective:
To describe a step-by-step approach to transcatheter paravalvular leak (PVL) closure after transcatheter aortic valve replacement (TAVR) using frame-based access through a self-expanding valve.
Key Steps:
An 85-year-old man with a 34-mm Evolut FX+ TAVR valve developed worsening heart failure. Multimodality imaging showed moderate to severe PVL with adverse left ventricular remodeling. Preprocedural computed tomography localized a dominant jet aligned with a misaligned diamond-shaped cell of the Evolut valve. A closure device was delivered through this cell, markedly reducing PVL.
Potential Pitfalls:
Inadequate multimodality imaging may cause incorrect leak localization, device malposition, or longer procedures. Challenges include crossing the PVL tract within the valve frame and avoiding leaflet interference. Balloon postdilation may fail in heavily calcified annuli and adds risk.
Take-Home Messages:
Severe calcification and commissural misalignment can limit balloon postdilation. Careful computed tomography planning can identify favorable frame-based access (eg, Evolut FX+ diamond cell) and enable effective PVL closure in selected anatomies.
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