Percutaneous Hybrid Approach for an Aortic Paravalvular Leak Associated With a Large Pseudoaneurysm

Closure of complex paravalvular leak (PVL) via percutaneous approach may be challenging.

Our case highlights the rare occurrence of a complex PVL that extended into a pseudoaneurysm with entry sites in the aorta and left ventricular outflow tract far apart. We performed a hybrid percutaneous approach with transapical closure of the left ventricular side and then retrograde transfemoral closure of the aortic side.

Patients treated surgically for infective endocarditis may exhibit postoperative changes, including the potential development of PVL. Weakening of the tissue in the tract may lead to aneurysmal growth. Percutaneous single-site exclusion would lead to incomplete treatment; hence, dual-entry closure (aortic and left ventricular outflow tract) is necessary to reduce PVL and prevent aneurysmal expansion.

This case explores the complexities of treating PVL associated with a long and serpiginous tract with aneurysmal growth. Single-site transcatheter exclusion is inadequate to reduce regurgitation and mitigate aneurysmal expansion for serpiginous PVL tracts associated with pseudoaneurysm.