title: Percutaneous closure of perivalvular leaks with Amplatzer occluders: feasibility, safety, and shortterm results.
abstract: OBJECTIVE
  Perivalvular leak (PVL) may have significant hemodynamic and/or hematological consequences, and re-do surgery is associated with considerable mortality and morbidity. Herein are reviewed the short-term results of percutaneous closure of PVLs using the Amplatzer occluder.
  
  
  METHODS
  Eleven patients (five males, six females; mean age 59.7 +/- 7.3 years; range: 46-67 years) were referred for percutaneous closure of PVL using the Amplatzer occluder. Patients presented with congestive heart failure (n = 2), hemolysis (n = 1), or both (n = 8). The average number of previous heart operations was 2.4 +/- 1.3 per patient; seven patients had undergone two or more operations. The procedure was performed under general anesthesia, with fluoroscopic and transesophageal echocardiographic guidance. Antegrade and retrograde approaches were used for the mitral and aortic leaks, respectively.
  
  
  RESULTS
  The PVLs were in the mitral position (n = 8), aortic position (n = 1), or both (n = 2). Device deployment was achieved in 11 (91.7%) of 12 attempted valves (10 patients, 90.9%). Failure to cross the leak with the wire occurred in one patient, and interruption of mitral leaflet movement occurred in two patients. Leakage was decreased in six patients (60%), but residual leak was observed at 10 of the 11 sites. Hemolysis was reduced in four patients, increased in four, and remained unchanged in two. An improved NYHA functional class of one grade was noted in five patients. One patient required a second operative session to seal a residual leak.
  
  
  CONCLUSIONS
  Percutaneous closure of PVL using the Amplatzer occluder is feasible, but technically demanding. Although symptoms were improved, there was an inconsistent effect on hemolysis. At present, the Amplatzer occluder should be reserved for poor surgical candidates.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. yshapira@post.tau.ac.il
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Rafael
authors.initials: R
authors.lastname: Hirsch
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Mordehay
authors.initials: M
authors.lastname: Vaturi
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Ralph
authors.initials: R
authors.lastname: Hein
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Alex
authors.initials: A
authors.lastname: Sagie
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D018084:Ultrasonography, Interventional