Successful Balloon Valvuloplasty for Paravalvular Leak 4 Months After TAVR in a Bicuspid Aortic Valve

Late detection of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) presents unique treatment challenges, especially in bicuspid valves, likely because of valve geometry and the mechanism of percutaneous anchoring.

A 70-year-old man underwent TAVR for bicuspid aortic stenosis using a balloon-expandable valve. Moderate to severe PVL was detected 4 months later. A multidisciplinary team evaluated the PVL etiology, patient anatomy, and available treatment options including valve-in-valve and plug closure. A partially fused commissural raphe causing focal underexpansion was identified as the origin of PVL, and late balloon valvuloplasty was performed successfully.

Unlike surgical-valve PVL, where percutaneous plug closure is the main treatment option, post-TAVR PVL offers additional approaches. Multimodality imaging helps define mechanism, feasibility, and risk.

Late balloon valvuloplasty is a safe option for underexpanded TAVR in bicuspid valves. Assessment of calcified raphe anatomy and the underexpansion site guides procedural risk and informs treatment selection.