Percutaneous Paravalvular Leak Closure

Abstract

Paravalvular leak (PVL) is a known complication of surgical and transcatheter valve replacement procedures. Patients most commonly present with congestive heart failure and/or hemolysis, and repeat surgical procedures to correct the PVL carries increased risk with reduced likelihood of success. As a result, percutaneous approaches to PVL closure have been developed, with a considerable emphasis on multimodality imaging for both diagnosis and procedural guidance in the cardiac catheterization laboratory. Large series' of percutaneous PVL closure have been recently published, with encouraging results with respect to both procedural success and clinical outcomes. In this paper, we provide a comprehensive review of imaging and procedural techniques for percutaneous PVL closure and present the data supporting this novel treatment strategy.

Computational Fluid Dynamics Simulations of Mitral Paravalvular Leaks in Human Heart

“…The main characteristics differentiating the geometries were the cross-sectional area (CSA) and shape. The studied geometries were generated based on the imaging data [ 8 , 35 , 36 , 37 ], and could be considered as representative of clinical cases of real-life PVLs. The wide channels ( Figure 2 a,c) were created to reproduce untreated PVLs, while the narrower channels ( Figure 2 b,d) were meant to represent PVLs that were not fully closed after the percutaneous closure.…”

Percutaneous Paravalvular Leak Closure

“…For the sake of consistency in nomenclature, the MV is viewed as a clock-face and leak origin defined by the position on the clock ( Figure 1A) from the left atrial (LA), or "surgeon's", view 14 . In a large surgical series, the most common location for mitral PVL was anteromedial (between 10 and 11 o'clock) and posterolateral (between 5 and 6 o'clock).…”

Closure of Three Separate Complex Paravalvular Defects with Four Devices By Transapical Approach

“…Paravalvular leaks (PVL) that complicate prosthetic valve replacement may be observed in 2%-12% of the patients after mitral valve replacement (MVR) and 1%-5% of the patients after aortic valve replacement (1) . Most of the patients who underwent PVL have a benign clinical course but 1%-5% of these patients present with the symptoms of congestive heart failure and hemolysis (1)(2)(3) .…”

“…Paravalvular leaks (PVL) that complicate prosthetic valve replacement may be observed in 2%-12% of the patients after mitral valve replacement (MVR) and 1%-5% of the patients after aortic valve replacement (1) . Most of the patients who underwent PVL have a benign clinical course but 1%-5% of these patients present with the symptoms of congestive heart failure and hemolysis (1)(2)(3) . Although surgical intervention is recommended in these patients with symptoms, a redo surgery carries a high recurrence rate along with a greater risk of morbidity and mortality than the initial procedure (1,2) .…”

“…Most of the patients who underwent PVL have a benign clinical course but 1%-5% of these patients present with the symptoms of congestive heart failure and hemolysis (1)(2)(3) . Although surgical intervention is recommended in these patients with symptoms, a redo surgery carries a high recurrence rate along with a greater risk of morbidity and mortality than the initial procedure (1,2) . Therefore, the percutaneous closure of PVL is considered as a less invasive alternative to a surgical closure for symptomatic relief in high-risk patients (4) .…”