Mitral Paravalvular Leak Closure Using a Percutaneous and Nonfluoroscopic Approach

Mitral paravalvular leak (PVL) is a serious complication after mechanical mitral valve replacement. We describe a step-by-step percutaneous and nonfluoroscopic (PAN) technique for mitral PVL closure guided exclusively by transesophageal echocardiography (TEE) to eliminate radiation exposure.

First, preprocedural anatomical assessment and device sizing use cardiac computed tomography and TEE. Next, under TEE guidance, transseptal puncture is performed, followed by steerable sheath positioning in the left atrium. Then, a guidewire is advanced across the defect, and a delivery sheath is positioned. Finally, an adequate working distance is established to ensure that the Amplatzer vascular plug is precisely deployed without interfering with the mechanical valve discs.

The PAN approach relies on high-quality TEE windows; suboptimal imaging or complex, calcified leaks may require fluoroscopic assistance.

The PAN approach for mitral PVL closure is a feasible and precise strategy that eliminates ionizing radiation while maintaining procedural safety in selected patients.