title: Percutaneous retrograde transfemoral closure of mitral paravalvular leak in 3 patients without construction of an arteriovenous wire loop.
abstract: Percutaneous closure of paravalvular leaks has emerged as an alternative to repeated surgeries. Different percutaneous techniques and various devices have been used, off-label, for paravalvular leak closure. For mitral leaks, antegrade transseptal, retrograde transfemoral, and retrograde transapical techniques have been developed. In the antegrade transseptal approach, an arteriovenous guidewire loop is often created to advance the delivery sheath. In retrograde transfemoral closure, the wire in the left atrium is usually snared after transseptal puncture, to pull it from the femoral vein. The delivery sheath and closure device will subsequently be deployed from the left atrium. Each of these procedures takes time, is costly, and increases the risk of complications. We present the cases of 3 patients in whom we closed mitral paravalvular leaks by means of a retrograde transfemoral approach, with use of an Amplatzer™ Duct Occluder II device and without the construction of an arteriovenous wire loop. We think that this approach can be very useful in a specific group of patients-reducing costs, fluoroscopy times, and complications related to transseptal puncture and construction of an arteriovenous wire loop. In our institution, this reported technique is routinely used for mitral paravalvular leak closure.
authors.affiliation: Department of Cardiology (Drs. Kilic, Sahin, and Ural), Kocaeli University Medical Faculty; and Invasive Cardiology Research and Application Unit (Drs. Kilic and Ural), Kocaeli University, 41380 Kocaeli, Turkey.
authors.forename: Teoman
authors.initials: T
authors.lastname: Kilic
authors.affiliation: Department of Cardiology (Drs. Kilic, Sahin, and Ural), Kocaeli University Medical Faculty; and Invasive Cardiology Research and Application Unit (Drs. Kilic and Ural), Kocaeli University, 41380 Kocaeli, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Sahin
authors.affiliation: Department of Cardiology (Drs. Kilic, Sahin, and Ural), Kocaeli University Medical Faculty; and Invasive Cardiology Research and Application Unit (Drs. Kilic and Ural), Kocaeli University, 41380 Kocaeli, Turkey.
authors.forename: Ertan
authors.initials: E
authors.lastname: Ural
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011475:Prosthesis Failure; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: Cardiac catheterization/instrumentation; heart valve prosthesis implantation/instrumentation/methods; mitral valve insufficiency/etiology/therapy; mitral valve/pathology; prosthesis implantation/adverse effects/methods; septal occluder device; treatment outcome