Catheter-based closure of aortic and mitral paravalvular leaks: existing techniques and new frontiers

Joseph, Tim; Lane, Conor M.; Fender, Erin A.; Zack, Chad J.; Rihal, Charanjit S.

doi:10.1080/17434440.2018.1514257

Cited by 16 publications

(12 citation statements)

References 56 publications

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“…Efforts are needed to develop new specifically designed devices to further improve clinical outcomes of this particular subset of high-risk patients with multiple comorbidities ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function?

Onorato

Vercellino

Costante

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAortic paravalvular leak (APVL) after surgical valve replacement (AVR) is an ominous complication with a high risk of morbidity and mortality. Approximately 1–5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or hemolytic anemia.Case SummaryA 69-year-old man with multiple comorbidities underwent surgical replacement of the aortic valve with a mechanical tilting disc prosthetic valve (Medtronic Starlight 27 mm). Several years later, recurrent episodes of congestive heart failure and hemolytic anemia developed due to a large crescent-shaped aortic PVL located at non coronary cusp (NCC) 9–12 o'clock, with moderate-to-severe regurgitation. The patient was deemed at prohibitive surgical risk due to significant multiple comorbidities and a transcatheter PVL closure (TPVLc) was planned. The huge PVL was partially closed by a first specifically designed paravalvular leak device (PLD). The procedure was complicated by transient interference of the second PLD with mechanical prosthetic valve function. This issue has however been solved with correct manipulation, orientation and downsizing of the second device implanted. At 3-month and 13-month follow-up, the patient showed a relevant clinical improvement and good quality of life. 2D TTE color Doppler confirmed the stable position of the two PLDs with trace residual leak.DiscussionSurgical redo has been considered the treatment of choice for symptomatic patients with PVLs. Notwithstanding, TPVLc is a less invasive alternative, particularly in patients at high surgical risk in whom early diagnosis and prompt interventional treatment are crucial for improving expectancy and quality of life. Dedicated devices, appropriate procedural techniques, and the close interaction between imaging modalities, allowed to deal successfully with a challenging case of severe symptomatic aortic PVL.

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“…Efforts are needed to develop new specifically designed devices to further improve clinical outcomes of this particular subset of high-risk patients with multiple comorbidities ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function?

Onorato

Vercellino

Costante

et al. 2022

Front. Cardiovasc. Med.

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“…Joseph et al . 8 reviewed techniques for percutaneous PVL closure and concluded that PVL closure is safe for most patients but associated with higher rates of residual leakage. Dedicated devices for PVL closure are needed to improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Management of severe haemolytic anaemia due to residual small mitral paravalvular leak post-percutaneous closure: a case report

Abuelatta

Khedr

Alharbi

et al. 2020

European Heart Journal - Case Reports

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Background Haemolytic anaemia is a complication of paravalvular leak (PVL). The correlation between the size of the leak and the severity of haemolysis is unclear. Small leaks can cause severe haemolysis, whereas significant leaks may cause no haemolysis. Case summary We report the case of a 40-year-old male who underwent mechanical mitral and aortic valve replacement 20 years ago. In the last 3 years, the procedure was repeated three times due to infective endocarditis. He presented with severe shortness of breath. A transoesophageal echocardiogram with three-dimensional surgical view showed that both discs of the mechanical mitral valve opened sufficiently but a severe PVL had occurred at the 9–12 o’clock position. The location of the mitral valve was abnormal, the sewing ring was inserted high at the mid-interatrial septum. The mechanical aortic valve functioned well. Closure of the transcutaneous PVL was accomplished with two percutaneously implanted devices, leaving a small leak in between. After closure, he developed haemolytic anaemia (haemoglobin: 6 g/dL, lactate dehydrogenase: 1896 units/L, reticulocyte count: 4.6%). He then received 16 units of packed red blood cells. He developed acute kidney injury and was started on haemodialysis. We then installed two additional devices to completely close the mild residual leak and another device to resolve the bidirectional transseptal defect. After 2 days, his renal function returned to normal and anaemia improved (haemoglobin: 9.1 g/dL). Discussion Mild residual paravalvular leak can cause severe haemolytic anaemia that is correctable via percutaneous closure of the leak.

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“…The incidence of PVL is about 6%–15%, 6 more common in mechanical prostheses and is reported to be around 2%–10% 7 in the aortic position. It is highly accepted that moderate‐to‐severe and severe PVL should be corrected as soon as possible, but as for mild‐to‐moderate or moderate PVL patients, there is no consensus regarding the optimal management 5 .…”

Section: Commentsmentioning

confidence: 99%

“…The incidence of PVL is about 6%-15%, 6 more common in mechanical prostheses and is reported to be around 2%-10% 7 in the aortic position. It is highly accepted that moderate-to-severe and…”

Section: Commentsmentioning

confidence: 99%

Four novel suture‐sealing techniques to repair varying size paravalvular leaks

Zheng

Tao

Davies

et al. 2021

Journal of Cardiac Surgery

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Background: Paravalvular leak (PVL) is a well-known complication of aortic valve replacement. Currently, there is no consensus on optimal intraoperative management of patients with mild-to-moderate or moderate PVL.Technique: In this paper we present four novel surgical techniques, each combining suturing with sealing technique, to repair aortic PVLs, nullifying the need to replace the prosthesis. Conclusion:These techniques will offer cardiac surgeons new alternatives to the repair techniques currently used.

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Catheter-based closure of aortic and mitral paravalvular leaks: existing techniques and new frontiers

Cited by 16 publications

References 56 publications

Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function?

Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function?

Management of severe haemolytic anaemia due to residual small mitral paravalvular leak post-percutaneous closure: a case report

Four novel suture‐sealing techniques to repair varying size paravalvular leaks

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