A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement

Abstract

Paravalvular leaks (PVL) are an uncommon sequelae of valve replacement but can be seen as a complication of both mechanic and prosthetic valves. Patients with PVL may remain asymptomatic or have detrimental complications, which include heart failure, hemodynamically significant hemolysis, and endocarditis. Management depends on the clinical presentation and the degree of the valvular leak. We hereby present a case report of a patient with a complicated clinical course secondary to a PVL of the mitral valve. The patient had a recent mitral valve replacement and presented with symptoms of heart failure that was refractory to standard medical therapy. Valvular abnormality was not seen with initial trans-thoracic echocardiogram (TTE), but with high clinical suspicion, a trans-esophageal echocardiogram (TEE) was done confirming a PVL. The patient's condition continued to deteriorate; he became hemodynamically unstable with end-organ damage. Cardiothoracic surgery was consulted for surgical repair of the PVL. The patient, however, remained too unstable for surgery and the family opted for comfort measures per the patient's wishes.

Incidence of valvular regurgitation and leaflet perforation by using automated titanium fasteners (CORKNOT®) in heart valve repair or replacement: less usual than reported

“…Additionally, Patients with PVL may remain asymptomatic for long period and can be associated with heart failure, hemolysis and/or endocarditis [ 17 ]. PVL has been known to be associated with heart valve surgery, despite the use of traditional hand-tie [ 18 , 19 ]…”

“…Additionally, Patients with PVL may remain asymptomatic for long period and can be associated with heart failure, hemolysis and/or endocarditis [17]. PVL has been known to be associated with heart valve surgery, despite the use of traditional hand-tie [18,19] Moderate to severe paravalvular leak was reported to be present in the range of 3-6% in studies done by O'Rourke et. Al [20], Smolka, G [21].…”