title: Evaluation of Aortic Paravalvular Leak: A Special Reference for Anatomical Localization.
abstract: Paravalvular leakage (PVL) remains an unavoidable complication of heart valve surgery and in its severe forms may lead to heart failure and hemolysis. The study aim was to evaluate the echocardiographic, clinical, surgical and laboratory characteristics of patients with aortic PVL.
  
  
  
  A total of 77 aortic PVL patients underwent transthoracic and transesophageal echocardiography examinations. Clinical, echocardiographical and surgical findings were also recorded.
  
  
  
  Among the 77 patients, 21 (27.3%) had mild, 33 (42.8%) had moderate and 23 (29.9%) had severe aortic PVL. Seventeen patients (22.1%) had moderate-to-severe hemolysis and had a higher incidence of multiple PVL compared to those with no or mild hemolysis. Moderate- to-severe PVL was more frequent between the non-coronary and the left coronary sinus annuli, especially adjacent to the left main coronary artery ostium. Percutaneous closure was performed in five patients. Eleven patients underwent surgical repair, and the localizations of PVL were in accordance with echocardiographic findings.
  
  
  
  Aortic PVL occurs more frequently between the non-coronary sinus and the left coronary sinus annuli, which may be associated with multiple factors. Difficulties in seating the prosthesis due to the steep angulation of the commissure and annulus, the avoidance of deep sutures, and focal annular calcification may make this region prone to injury and leakage.
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey. Electronic correspondence: m.ozangursoy@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozan Gürsoy
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Macit
authors.initials: M
authors.lastname: Kalçık
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.|School of Health Sciences, Ardahan University, Ardahan, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Özkan
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ali Astarcıoğlu
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.|Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Karakoyun
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Gündüz
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.|Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey.
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.affiliation: Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yesin
authors.affiliation: Department of Cardiovascular Surgery, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Altuğ Tuncer
authors.affiliation: Department of Cardiovascular Surgery, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Köksal
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation