Diagnosis and Treatment of Left-Sided Prosthetic Paravalvular Regurgitation

Abstract

Paravalvular leak (PVL) is a complication related to the surgical implantation of left-sided prosthetic valves. The prevalence of paravalvular regurgitation ranges between 5 and 20%. Left-sided prosthetic paravalvular regurgitation presents with a wide constellation of signs and symptoms ranging from asymptomatic murmur to heart failure, hemolysis and cardiac cachexia. Echocardiography plays a key role in imaging the PVL and can help in guiding the closure procedure with both transesophageal and intracardiac probes. Transcatheter closure of paravalvular regurgitations is an appealing prospect.

Comparison of transcatheter and surgical treatment of paravalvular leak: Results from a 5‐year follow‐up study

“…This condition occurs in 2–10% and 7–17% of aortic and mitral valve replacements , respectively. The majority of patients with PVL remains asymptomatic; however, 1–5% of those patients have significant congestive heart failure and/or refractory hemolysis with a mortality rate of 6–15% . PVL is often a consequence of underlying endocarditis, annular calcification, tissue degeneration, and inflammation.…”

Mitral Paravalvular Leak: Clinical Implications, Diagnosis and Management

“…Three-dimensional (3D) TEE achieves better definition, and it has been shown to be superior to 2D-TEE to study PVLs [ 9 , 10 , 11 ]. 3D images allow us to find out the shape (crescent-shaped vs. round), valve dehiscence, the distance from the sewing ring, the orientation and movement of prosthetic leaflets and the degree of regurgitation as well as helping us to improve the identification and quantification of multiple regurgitant jets [ 12 ]. Indeed, 3D-TEE is the recommended technique to guide percutaneous PVL closure procedures (especially in mitral location), as well as playing an important role in selection of the most appropriate closure device [ 8 , 11 , 13 , 14 ].…”