title: Off-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem.
abstract: A 60-year old male patient with multiple risk factors and two previous interventions over the mitral valve was admitted to the emergency unit with symptoms of cardiac failure. Initial examination revealed a competent mitral bioprosthesis with severe perivalvular mitral insufficiency. Based on previous experiences with transapical procedures, a transapical transcatheter closure of the perivalvular leak was performed. The apex was punctured with a 7 French introducer sheath, and a hydrophilic guidewire was advanced with the aid of a right Judkins catheter and positioned across the defect in the left atrium. Fluoroscopic and tridimensional transoesophageal echocardiography was used to guide the manoeuvre. Next, a long introducer sheath was advanced through the guidewire and positioned inside the left atrium. Two Amplatzer Vascular Plug II (St Jude Medical) were deployed, resulting in a significant reduction in the perivalvular leak. The procedure was considered to be successful. The patient regained consciousness, and the orotracheal tube was removed in the operating theatre. No neurological deficits were detected, and the patient was transferred to the intensive care unit. The patient recovered well and was transferred to the ward after 1 day. Discharge was accomplished after 4 days.
authors.affiliation: Department of Cardiovascular Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Diego Felipe
authors.initials: DF
authors.lastname: Gaia
authors.forename: João Roberto
authors.initials: JR
authors.lastname: Breda
authors.forename: Claudio Henrique
authors.initials: CH
authors.lastname: Fischer
authors.forename: José Honório
authors.initials: JH
authors.lastname: Palma
mesh_terms: D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016896:Treatment Outcome
keywords: Cardiac catheterization/intervention; Heart valve; Mitral valve; Percutaneous; Transapical