Principles of Percutaneous Paravalvular Leak Closure

Abstract

Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for characterizing the defect location, size, and shape. For paramitral defects, an antegrade transseptal approach can usually be guided by biplane fluoroscopy, and real-time 3-dimensional transesophageal echocardiography can usually be performed successfully. Alternative approaches to paramitral defects include retrograde transaortic cannulation or transapical access and retrograde cannulation. For oblong or crescentic defects, the simultaneous or sequential deployment of 2 smaller devices, as opposed to 1 large device, results in a higher degree of procedural success and safety because the risk of impingement on the prosthetic leaflets is minimized. Most para-aortic defects can be approached in a retrograde manner and closed with a single device. With careful anatomical assessment, procedural planning, and procedural execution, successful closure rates of 90% or more should be attainable with a low risk of device impingement on the prosthetic valve or embolization.

Percutaneous Treatment Options for Recurrent Mitral Valve Disease after Failed Mitral Valve Surgery

“…The rate of mild paravalvular MR of 33% in our cohort reflects the results of others [26]. Considering an occurrence rate of paravalvular MR after surgical MV replacement in native valves between 5-17% [32], these initial studies may suggest that paravalvular MR are more likely to occur during VIR and VIV. Access route might play a role in this regard as optimal axonal orientation of the prosthetic valve within the annuloplasty ring is more easily reached using an apical compared to a transseptal approach.…”

New methods in diagnostic and therapy Coaxial telescopic catheters systems in percutaneous diagnostic and therapeutic procedures

“…Another application field for telescopic systems is an intervention in patients with structural heart diseases such as paravalvular leaks and/or acquired defects of the left ventricular wall [14,15].…”

Combined Retrograde/Antegrade Approach to Transcatheter Closure of an Aortic Paravalvular Leak

“…The reasons for PVL include tissue friability, annular calcification, and infection. 1 Although some PVL patients remain asymptomatic for many years, others develop congestive heart failure or hemolysis and need reoperation. Transcatheter closure by implanting an occluder device has become an alternative to surgery for leak closure; treatment of an aortic PVL can often, in fact, be performed via a femoral artery retrograde approach, with the aid of echocardiographic and fluoroscopic guidance.…”

“…Transcatheter closure by implanting an occluder device has become an alternative to surgery for leak closure; treatment of an aortic PVL can often, in fact, be performed via a femoral artery retrograde approach, with the aid of echocardiographic and fluoroscopic guidance. 1 An antegrade approach can be substituted if retrograde treatment cannot be performed; access for antegrade treatment can be via the femoral vein and transseptal puncture, or via a left ventricular (LV) transapical approach. 1 We report the closure of an aortic PVL via a combined retrograde/antegrade approach, which became necessary because neither the simple retrograde nor the antegrade approach could be completed.…”

“…1 An antegrade approach can be substituted if retrograde treatment cannot be performed; access for antegrade treatment can be via the femoral vein and transseptal puncture, or via a left ventricular (LV) transapical approach. 1 We report the closure of an aortic PVL via a combined retrograde/antegrade approach, which became necessary because neither the simple retrograde nor the antegrade approach could be completed.…”