Background: Paravalvular leak refers to blood flowing through a channel between the structure of the implanted valve and cardiac tissue as a result of a lack of appropriate sealing. PVL is most commonly observed with mechanical valves followed by bioprosthetic valves. Incidence of PVL, including small non-significant jets, is estimated to be as high as 20%. PVL is also more common with mitral (up to 20%) than aortic prosthetic valves. The presence of clinically overt PVLs that warrant repair has occurred in 1-5% of patients with prosthetic valves. PVL is most commonly related to disruption of sewing ring sutures precipitated by infectious endocarditis or significant calcification and fibrotic scar of the annulus. Technical factors during the surgical procedure may also play a role. The leak may have significant hemodynamic and/ or hematological consequences; the re-do surgery in these cases reportedly associated with high morbidity and mortality.
Methods: Thirty six patients (20 females and 16 males); mean age (59.9 years; range 53-82 years) were referred for percutaneous closure of PVL, using Amplatzer type occluders. Most patients presented with congestive heart failure, hemolysis or both. The average number of previous heart surgeries was 2.5 +/- 1.2 per patient. The procedure was performed under general anesthesia, with fluoroscopic and transesophageal echocardiographic guidance. Antegrade (trans-septal puncture) and retrograde approaches were used as all as trans-apical.
Postero - lateral and antero - lateral locations of leaks were more favorable for closure, vs. medial and postero-medial leaks.
Results: Device deployment was achieved in 32 cases (91%) of 36 attempted procedures. Failure to cross leak with wire occurred in three patients.
Residual leak observed in 25 patients. Hemolysis was reduced in most patients and improvement in NYHA functional class of one grade was noted in 10 patients.
Conclusion: Percutaneous closure of PVL is feasible and safe. Medial and postero-medial locations were more technically demanding. Symptoms were improved in most, but not all patients.
At present this procedure should be reserved for poor surgical candidates.
