title: Paravalvular leaks: mechanisms, diagnosis and management.
abstract: OBJECTIVE
  To understand the incidence, aetiology and mechanisms of paravalvular aortic and mitral leaks after valvular surgery; reviewing the best methods for diagnosis, procedural guidance and result assessment of these leaks, as well as describing the different approaches to their treatment.
  
  
  RESULTS
  A literature search was undertaken as well as an in-depth analysis of our own experience concerning different imaging modalities and various therapeutic strategies for aortic and mitral paravalvular leaks. The majority of patients were diagnosed using two- or three-dimensional transoesophageal echocardiography, useful in both guiding the procedure as well as assessing the procedural results. Haemoglobin, haematocrit, LDH and haptoglobin values were analysed to assess haemolysis. Procedural success for percutaneous closure of paravalvular aortic leaks are around 90% in the different series, with low complication rates. Mitral leaks have been approached by transfemoral and transapical access; the reported success of this procedure ranges from 75% to more than 90% in different reports. Complication rates at 30 days average 10% and mortality related to the procedure is around 1%. Late follow-up results depend on the initial anatomy, baseline clinical class and procedure results.
  
  
  CONCLUSIONS
  Paravalvular leaks after surgical valve implantation have a multifactorial aetiology, but are mainly related to specific anatomic characteristics of the valvular ring. Mitral leaks are three times more common than aortic leaks and the incidence increases after reoperation. Different percutaneous techniques with several devices have been explored for leak closure, but we are still lacking devices specifically designed to treat this pathology more effectively.
authors.affiliation: Interventional Cardiology, Cardiac Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain. ejgarcia1@telefonica.net
authors.forename: Eulogio
authors.initials: E
authors.lastname: García
authors.forename: Jorge
authors.initials: J
authors.lastname: Sandoval
authors.forename: Leire
authors.initials: L
authors.lastname: Unzue
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernandez-Antolin
authors.forename: Carlos
authors.initials: C
authors.lastname: Almería
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D003952:Diagnostic Imaging / Q000379:methods; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012307:Risk Factors; D016896:Treatment Outcome