title: Two-step approach of percutaneous closure of a paravalvular leak and atrial septal defect after mitral valve reoperation.
abstract: Severe paravalvular leakage following mitral valve replacement, a rare but potentially serious complication, may result in heart failure and significant hemolysis. Reoperation is considered standard of care. However, in selected patients, re-do sternotomy carries excessively high surgical risk. Percutaneous closure of paravalvular leaks has become a viable option for these patients. We present a case of a highly symptomatic 42-year-old male who underwent successful percutaneous closure of two paravalvular leaks and a post-operative atrial septal defect after re-do mitral valve replacement surgery. As access to the left atrium was expected to be difficult following percutaneous atrial septal defect closure, a two-step approach of paravalvular leak closure followed by atrial septal defect closure was chosen. Difficulties of atrial septal defect closure following closure of a paravalvular leak next to the inter-atrial septum will be discussed.
authors.affiliation: Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
authors.forename: Narin
authors.initials: N
authors.lastname: Sriratanaviriyakul
authors.forename: Chari
authors.initials: C
authors.lastname: Hart
authors.forename: Christian
authors.initials: C
authors.lastname: Spies
mesh_terms: D000328:Adult; D054087:Atrial Septum / Q000293:injuries; D006328:Cardiac Catheterization / Q000295:instrumentation; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005471:Fluoroscopy; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D055989:Septal Occluder Device; D016896:Treatment Outcome