Percutaneous closure of prosthetic paravalvular leaks: case series and review.
BACKGROUND
Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valve replacement. Most are asymptomatic and benign, but some may cause symptoms due to a large regurgitant volume or hemolysis. Medical therapy is palliative, while reoperation carries significant morbidity and mortality. Percutaneous transcatheter closure techniques, now routinely applied in the management of pathological cardiac and vascular communications, may be adaptable to PVL closure, potentially offer symptomatic relief.


METHODS
We reviewed our experience with attempted percutaneous closure of PVLs, using data from medical and procedural records.


RESULTS
Between 2001 and 2004, 14 procedures were performed in 10 patients, all under general anesthesia, with transesophageal and radiographic guidance. Mitral (9) and aortic (1) valve replacements were involved, both mechanical and bioprosthetic. A variety of devices were used, including atrial septal occluders, patent ductus arteriosus occluders, and coils (all of label use). Six had a single procedure, which was technically successful in four: in two, the PVL could not be crossed. Four underwent a second procedure, which was technically successful in three; in one the previously deployed device was dislodged necessitating urgent, but ultimately uneventful, surgical removal and leak repair. One patient had transient severe hemolysis, which resolved after 1 week. At 1-year follow-up (9/10 pts) three had died, five had sustained symptomatic improvement while 1 patient with a residual leak still required regular blood transfusions.


CONCLUSIONS
Percutaneous closure of PVLs is time-consuming but feasible in selected patients, with a reasonable degree of technical and clinical success. A second procedure may be necessary and a variety of complications can occur.
Pate
Gordon E
GE
Division of Cardiology, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Al Zubaidi
Abdul
A
Chandavimol
Mann
M
Thompson
Christopher R
CR
Munt
Bradley I
BI
Webb
John G
JG
D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D011475:Prosthesis Failure