Percutaneous Closure of Paravalvular Leak from a Rocking Mitral Valve in a 74-Year-Old Man at High Surgical Risk
Dehiscence of a prosthetic heart valve or excessive rocking during the cardiac cycle is thought to preclude percutaneous paravalvular leak closure. However, surgical repair of paravalvular leak is associated with recurrent dehiscence and poor outcomes. We present the case of a symptomatic 74-year-old man in whom we performed percutaneous anchoring, involving multiple plugs and multimodal imaging, to stabilize a rocking mitral valve and close a substantial paravalvular leak caused by dehiscence. To our knowledge, using this technique to correct both conditions is novel.
Two-dimensional transesophageal echocardiogram (color-flow Doppler mode) shows an anterolateral paravalvular leak with a regurgitant jet directed toward the left atrial appendage (arrow). The valve's lateral portion rocked during the cardiac cycle, with prolapse above the plane of the mitral annulus during systole.
Cardiac computed tomogram (short-axis view) in systole (34% of the R-R interval) shows a 23 × 11-mm area of valvular dehiscence (arrow), enabling direct communication between the left atrium and left ventricular outflow tract anterolaterally at the level of the mitral prosthesis.
Fluoroscopic views show A) the guidewire that was advanced transseptally through the paravalvular leak, snared, pulled into the aorta, and pulled out through the femoral artery; B) the initial 12-mm plug and the 14-mm plug that successfully anchored the prosthesis; and C) successful paravalvular leak closure (left anterior oblique view).
Three-dimensional transesophageal echocardiogram (color-flow Doppler mode) shows successfully deployed vascular plugs, trace residual paravalvular leak, and normally functioning prosthetic mitral leaflets.
Supplemental motion image is available for Figure 4.
Contributor Notes
Drs. Babaliaros and Lerakis consult for Abbott Vascular.
