Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

Pang, Philip Y.K.; Zhu, Jiasi; Sin, Yoong Kong; Chua, Yeow Leng

doi:10.21037/jtd.2016.08.58

Cited by 4 publications

(13 citation statements)

References 6 publications

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“…Surgery is preferred in patients who have large, severe PVL, failed conservative medical management, or present with refractory heart failure. Percutaneous closure is contraindicated in active endocarditis, intra-cardiac thrombi, and a large PVL involving more than one-third of the prosthetic annulus [ 7 ]. We were able to establish the significance of TEE and its diagnostic value in determining the presence of PVL.…”

Section: Discussionmentioning

confidence: 99%

A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement

Khan¹,

Taweesedt²,

Venkatachalam³

et al. 2020

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement

Khan¹,

Taweesedt²,

Venkatachalam³

et al. 2020

Cureus

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“…The main indications include the presence of dyspnea, clinically significant anemia, and moderately severe or severe paravalvular prosthetic regurgitation. It is possible to have both early and late postoperative PVLs 35 . Medication is first used to improve symptoms.…”

Section: Timing Of the Pvl And Treatment Approachmentioning

confidence: 99%

“…Another study reports the surgical management used in six patients who developed a mitral PVL postoperatively extremely late (approximately 16 years) 35 . The patients had presented with congestive cardiac failure and hemolytic anemia.…”

Section: Timing Of the Pvl And Treatment Approachmentioning

confidence: 99%

“…The patients had presented with congestive cardiac failure and hemolytic anemia. Transcatheter closure had failed in two patients due to either residual regurgitation or the interference of the existing prosthesis with the closure device 35 . Five patients who had a calcified annulus underwent PVL suture repair without removing the existing prosthesis 35 .…”

Section: Timing Of the Pvl And Treatment Approachmentioning

confidence: 99%

“…Transcatheter closure had failed in two patients due to either residual regurgitation or the interference of the existing prosthesis with the closure device 35 . Five patients who had a calcified annulus underwent PVL suture repair without removing the existing prosthesis 35 . After removing of the existing prosthesis, one patient had to undergo mitral valve replacement 35 .…”

Section: Timing Of the Pvl And Treatment Approachmentioning

confidence: 99%

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The management of paravalvular leaks post aortic valve replacement

Kananathan¹,

Perera²,

Mohanarajan³

et al. 2022

Journal of Cardiac Surgery

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Background: Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions.Aim: To discuss the classification of PVLs, diagnostic approaches, and available management options.Method: A literature review was performed using 28 studies.Results: This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes.Discussion: Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place. Conclusion:Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.

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Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation

Jenab,

Nourian,

Hosseini Mohammadi

et al. 2024

Clinical Cardiology

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Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV‐node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.

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Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

Cited by 4 publications

References 6 publications

A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement

A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement

The management of paravalvular leaks post aortic valve replacement

Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation

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