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Jenab Y, Nourian S, Hosseini Mohammadi NS, Mohseni‐Badalabadi R, Hosseini K, Zakavi S, Ates I. Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation. Clin Cardiol 2024; 47:e24272. [PMID: 38742736 PMCID: PMC11092304 DOI: 10.1002/clc.24272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Nourian
- Firoozgar Clinical Research and Development CenterIran University of Medical SciencesTehranIran
| | - Negin Sadat Hosseini Mohammadi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical ScienceTehranIran
| | - Reza Mohseni‐Badalabadi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical ScienceTehranIran
| | - Sarina Zakavi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Students' Scientific Research Center (SSRC)Tehran University of Medical ScienceTehranIran
| | - Ismail Ates
- Faculty of HealthscienceBahcesehir UniversityIstanbulTurkey
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Kamran MM, Gopi A, Lakhani Z, Shaik A, Musthafa J, Raghuram G, Musthafa PPM. Utility of Konar-Multifunctional Occluder in Complex Situations: Unconventional Uses in Rare Situations. Pediatr Cardiol 2024; 45:121-132. [PMID: 38103070 DOI: 10.1007/s00246-023-03358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
KONAR-MFO (multifunctional occluder) [Lifetech, Shenzhen, China] was first used in humans in 2013 and received the CE mark in May 2018. As name suggest, it can be use in various(multifunctional) situations in paediatric as well as adults. This is a versatile device with an improved delivery and flexibility which make this device a better option to be use with more comfort and minimum complications. This paper is regarding few rare and complicated lesions, like anomalous origin of coronary artery from pulmonary artery (ALCAPA) device closure, device closure of ventricular septal rupture (VSR) post myocardial infarction in sick elderly and finally device closure of paravalvar leak (PVL)after mitral valve replacement which were treated with this device with excellent results. This study is a retrospective review from a tertiary level dedicated cardiac referral centre in south India. Three cases we are reporting here in which Konar-multifunctional occluders were used in locations other than commoner and regular defects like patent ductus arteriosus, ventricular septal defect etc, over the span of one year between April 2022 and March 2023. Pre-procedure, all patients underwent detailed clinical evaluation followed by transthoracic echocardiography, 12-lead electrocardiogram, and Chest X-ray at the outpatient department. All patients were either symptomatic or had a hemodynamically significant lesion on echocardiography. The decision for transcatheter management was taken after discussing with surgical team in view of either high risk surgery or refusal from patients for surgical options. All patients were followed up post procedure at regular intervals with transthoracic echocardiograms and 12-lead electrocardiograms for a minimum period of 6 months. All these three cases mentioned in our study underwent a complete closure of their respective lesions with no evidence of residual shunt. None of these patients had any major complications, prolonged stay, or any vascular injuries. All patients completed minimum 6-month follow-up and were doing well without any residual flows. First case of ALCAPA, after procedure showed improvement in IVCD, QTc duration and also no significant ischemic changes were noted. Myocardial perfusion scintigraphy was done after 6 months of procedure which showed improvement in contractile function and perfusion of left ventricle. Second case of VSR device closure patient showed immediate significant symptomatic improvement. He was transferred to the coronary care unit, and discharged seven days later. As of now the patient is alive and feeling well with no residual shunt detected by transthoracic echocardiography. No procedure -related complications have been recorded during last two years. Third case of PVL device closure had uneventful recovery from anaesthesia. Prosthetic valve functioned normally during the 5 days of post-procedure hospitalization. The transthoracic 2D- echocardiography performed during follow-up at the end of one month showed no mitral PVL.During follow-up after 1 year, the patient improved symptomatically. Normal prosthetic valve function and no leakage documented on transthoracic echocardiography. Konar-MFO emerging as an important occluder with interesting attributes which makes it a very useful asset to have in catheterizations laboratory.
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Affiliation(s)
- Mirza Mohd Kamran
- Department of Paediatric Cardiology and Cardiac Surgery, Metromed International Cardiac Centre, Calicut, Kerala, India.
| | - Arun Gopi
- Department of Cardiology, Metromed International Cardiac Centre, Calicut, Kerala, India
| | | | - Amira Shaik
- Department of Paediatric Cardiology and Cardiac Surgery, Metromed International Cardiac Centre, Calicut, Kerala, India
| | - Janeel Musthafa
- Department of Paediatric Cardiology and Cardiac Surgery, Metromed International Cardiac Centre, Calicut, Kerala, India
| | - G Raghuram
- Department of Paediatric Cardiology and Cardiac Surgery, Metromed International Cardiac Centre, Calicut, Kerala, India
- Department of Cardiology, Metromed International Cardiac Centre, Calicut, Kerala, India
| | - P P Mohammed Musthafa
- Department of Cardiology, Metromed International Cardiac Centre, Calicut, Kerala, India
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Jędrzejek M, Peszek-Przybyła E, Jadczyk T, Zemik J, Piprek P, Pysz P, Kozłowski M, Wojakowski W, Smolka G. 3D printing from transesophageal echocardiography for planning mitral paravalvular leak closure - feasibility study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:270-276. [PMID: 37854960 PMCID: PMC10580856 DOI: 10.5114/aic.2023.131481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Transcatheter closure of paravalvular leak (PVL) is still a demanding procedure due to the complex anatomy of PVL channels and risk of interference between the implanted occluder and surrounding structures. Efforts are made to improve procedural outcomes in transcatheter structural heart interventions by establishing treatment strategy in advance with the use of 3D-printed physical models based on data obtained from cardiac computed tomography (CT) studies. Aim In this feasibility study 3D printing of PVL models based on data recorded during transesophageal echocardiography (TEE) examinations was evaluated. Material and methods 3D-TEE data of patients with significant PVL around mitral valve prostheses were used to prepare 3D models. QLab software was used to export DICOM images in Cartesian DICOM format of each PVL with the surrounding tissue. Image segmentation was performed in Slicer, a free, open-source software package used for imaging research. Models were printed to actual size with the Polyjet printer with a transparent, rigid material. We measured dimensions of PVLs both in TEE recordings and printed 3D models. The results were correlated with sizes of occluding devices used to close the defects. Results In 7 out of 8 patients, there was concordance between procedurally implanted occluders and pre-procedurally matched closing devices based on 3D-printed models. Conclusions 3D-printing from 3D-TEE is technically feasible. Both shape and location of PVLs are preserved during model preparation and printing. It remains to be tested whether 3D printing would improve outcomes of percutaneous PVL closure.
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Affiliation(s)
- Marek Jędrzejek
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ewa Peszek-Przybyła
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Tomasz Jadczyk
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jakub Zemik
- Faculty of Sciences and Technology, University of Silesia, Katowice, Poland
| | - Paulina Piprek
- Doctoral School, Medical University of Silesia, Katowice, Poland
| | - Piotr Pysz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michał Kozłowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Rahman SU, Prasad K, Akram MS, Adoni N, Mehta S. A Treatment Dilemma: Bentall vs Transcatheter Paravalvular Leak Closure with Aortic Aneurysm Repair in a High Surgical Risk Patient. Cureus 2023; 15:e43765. [PMID: 37600434 PMCID: PMC10439814 DOI: 10.7759/cureus.43765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 08/22/2023] Open
Abstract
This case presentation involves an 80-year-old male with a history of surgically repaired patent ductus arteriosus and surgical aortic valve replacement due to infective endocarditis, who presented with progressive heart failure symptoms and was found to have a severe aortic paravalvular leak (PVL) and ascending thoracic aortic aneurysm. Due to complex surgical anatomy and multiple chronic comorbidities, he was considered a poor candidate for traditional valve replacement surgery including the Bentall procedure. Instead, a multidisciplinary team opted for transcatheter paravalvular leak closure (TPLC) with an Amplatzer plug followed by planned endovascular aortic aneurysm repair. The patient showed significant improvement in symptoms and reduction in aneurysm size post-procedure leading to avoidance of the open-heart surgery. This case highlights the effectiveness of the percutaneous approach in high-risk surgical patients with PVL and complex anatomical considerations.
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Affiliation(s)
- Saad Ur Rahman
- Internal Medicine, Carle Illinois College of Medicine, Urbana, USA
- Internal Medicine, Carle Health, Urbana, USA
| | | | | | - Naveed Adoni
- Interventional Cardiology, Carle Foundation Hospital, Urbana, USA
| | - Sanjay Mehta
- Cardiology, Carle Foundation Hospital, Urbana, USA
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Sehgal S, Subramanyam P, Ahluwalia M, Rastogi A, Bergman G. Transcatheter mitral valve implantation: Implications of interventional technique and 3D echocardiography for complex valve-in-valve paravalvular leak. Ann Card Anaesth 2023; 26:227-231. [PMID: 37706394 PMCID: PMC10284472 DOI: 10.4103/aca.aca_166_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/07/2022] [Accepted: 07/09/2022] [Indexed: 09/15/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve-in-valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve-in-valve PVL are limited. We present a case of a symptomatic patient with severe valve-in-valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve-in-valve-in-valve implantation with a 29 mm Edwards® SAPIEN 3 valve via transseptal approach using three-dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve-in-valve PVL closures.
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Affiliation(s)
- Sankalp Sehgal
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Cardiothoracic Anesthesia, Critical Care and Pain Medicine, 330 Brookline Ave, Boston, MA, USA
| | - Pritha Subramanyam
- Weill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NY, USA
| | - Monica Ahluwalia
- Boston Medical Center, Boston University School of Medicine, Division of Cardiovascular Medicine, 72 E. Concord St, Boston, MA, USA
| | - Ashish Rastogi
- Owensboro Health Cardiology, 1301 Pleasant Valley Road, Owensboro, KY, USA
| | - Geoffrey Bergman
- Weill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NY, USA
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Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience. J Clin Med 2022; 11:jcm11164835. [PMID: 36013075 PMCID: PMC9409651 DOI: 10.3390/jcm11164835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Paravalvular leak occurs in 5–17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. Methods: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. Results: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. Conclusions: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.
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Ozden O, Kemal H, Bingöl G, Göktekin Ö. Percutaneous closure of a paravalvular leak from a prosthetic mitral valve dehiscence in a young high-risk patient: case report. Eur Heart J Case Rep 2022; 6:ytac242. [PMID: 35854885 PMCID: PMC9290529 DOI: 10.1093/ehjcr/ytac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Paravalvular leak (PVL) is a common, serious complication related with prosthetic valve replacement. Although surgical closure reoperation is the choice of treatment, percutaneous device closure is a good alternative with good results in patients with very high surgical risk. CASE SUMMARY In this case report, we present the percutaneous closure of PVL of mitral valve replacement (MVR), in a patient with cardiogenic shock who failed conservative medical treatment and was deemed inoperable due to recurrent operations. Successful closure of the PVL with the use of the four consecutive PVL closure devices was performed under general anaesthesia with guidance of 2D and 3D transoesophageal echocardiography. The procedure was performed with no complications and the patient has remained asymptomatic after 10 months following the PVL closure procedure with marked improvement in her NYHA class and echocardiographic values. DISCUSSION Percutaneous PVL closure is a very challenging and high clinical skills requiring procedure, but has a good success and low complication rate in high-risk patients. It is not a standard procedure and the type and size of device should be tailored for each patient with a good 2D and 3D echocardiographic guidance.
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Affiliation(s)
- Ozge Ozden
- Corresponding author. Tel: +90 53 2270 5608, Fax: +90 39 2223 6461,
| | - Hatice Kemal
- Cardiology Department, Near East University Hospital, Nicosia, Turkish Republic of Northern Cyprus
| | - Gülsüm Bingöl
- Cardiology Department, Memorial Bahçelievler Hospital, Bahçelievler Merkez, Adnan Kahveci Blv. No. 227, 34180 Bahçelievler, İstanbul, Turkey
| | - Ömer Göktekin
- Cardiology Department, Memorial Bahçelievler Hospital, Bahçelievler Merkez, Adnan Kahveci Blv. No. 227, 34180 Bahçelievler, İstanbul, Turkey
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Kananathan S, Perera LA, Mohanarajan M, Sherif M, Harky A. The management of paravalvular leaks post aortic valve replacement. J Card Surg 2022; 37:2786-2798. [PMID: 35695718 DOI: 10.1111/jocs.16672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions. AIM To discuss the classification of PVLs, diagnostic approaches, and available management options. METHOD A literature review was performed using 28 studies. RESULTS This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes. DISCUSSION Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place. CONCLUSION Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.
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Affiliation(s)
- Shalini Kananathan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | | | - Maneeshaa Mohanarajan
- Dnipro Medical Institute of Traditional and Non-Traditional Medicine, Dnipro, Ukraine
| | - Mohamed Sherif
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Onorato EM, Alamanni F, Muratori M, Smolka G, Wojakowski W, Pysz P, Zorinas A, Zakarkaite D, Eltchaninoff H, Litzer PY, Godart F, Calvert P, Christou C, Mussayev A, Missiroli B, Buzaev I, Curello S, Tesorio T, Bartorelli AL. Safety, Efficacy and Long-Term Outcomes of Patients Treated with the Occlutech Paravalvular Leak Device for Significant Paravalvular Regurgitation. J Clin Med 2022; 11:jcm11071978. [PMID: 35407584 PMCID: PMC8999580 DOI: 10.3390/jcm11071978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Between December 2014 and March 2021, 144 patients with aortic (Ao) or mitral (Mi) paravalvular leaks (PVLs) were enrolled at 21 sites in 10 countries. Safety data were available for 137 patients, who were included in the safety analysis fraction (SAF), 93 patients with Mi PVLs and 44 patients with Ao PVLs. The full analysis set (FAS) comprised 112 patients with available stratum (aortic/mitral leak) as well as baseline (BL), 180-day or later assessments (2 years). Procedural success (implantation of the device with a proper closure of the PVL, defined as reduction in paravalvular regurgitation of ≥one grade as assessed by echocardiography post implantation) was achieved in 91.3% of FAS patients with Mi PVLs and in 90.0% of those with Ao PVLs. The proportion of patients suffering from significant or severe heart failure (HF), classified as New York Heart Association (NYHA) class III/IV, decreased from 80% at baseline to 14.1% at 2-year follow-up (FAS). The proportion of FAS patients needing hemolysis-related blood transfusion decreased from 35.5% to 3.8% and from 8.1% to 0% in Mi patients and Ao patients, respectively. In total, 35 serious adverse events (SAEs) were reported in 27 patients (19.7%) of the SAF population. The SAEs considered possibly or probably related to the device included device embolization (three patients), residual leak (two patients) and vascular complication (one patient). During follow-up, 12/137 (8.8%) patients died, but none of the deaths was considered to be device-related. Patients implanted with the Occlutech Paravalvular Leak Device (PLD) showed long-lasting improvements in clinical parameters, including NYHA class and a reduced dependency on hemolysis-related blood transfusions.
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Affiliation(s)
- Eustaquio Maria Onorato
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
- Correspondence:
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
| | - Manuela Muratori
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
| | - Grzegorz Smolka
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Wojtek Wojakowski
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Piotr Pysz
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Aleksejus Zorinas
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (A.Z.); (D.Z.)
| | - Diana Zakarkaite
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (A.Z.); (D.Z.)
| | - Hélène Eltchaninoff
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, 76000 Rouen, France; (H.E.); (P.-Y.L.)
| | - Pierre-Yves Litzer
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, 76000 Rouen, France; (H.E.); (P.-Y.L.)
| | - François Godart
- Department of Pediatric Cardiology and Congenital Heart Disease, University of Lille, 59000 Lille, France;
| | - Patrick Calvert
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
| | | | | | - Bindo Missiroli
- Gemelli Molise di Campobasso-Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 86100 Campobasso, Italy;
| | - Igor Buzaev
- Cardiovascular Department, Bashkir State Medical University, 450008 Ufa, Russia;
| | | | - Tullio Tesorio
- Department of Invasive Cardiology, Clinica Montevergine, 83013 Mercogliano, Italy;
| | - Antonio Luca Bartorelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20122 Milan, Italy
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Cruz-Gonzalez I, Antunez-Muiños P, Lopez-Tejero S, Sanchez PL. Mitral Paravalvular Leak: Clinical Implications, Diagnosis and Management. J Clin Med 2022; 11:1245. [PMID: 35268336 PMCID: PMC8911516 DOI: 10.3390/jcm11051245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Paravalvular leak incidence after mitral surgical replacement ranges from 7% to 17%. Between 1% and 5% of these are clinically significant. Large PVLs can cause important clinical manifestations such as heart failure or haemolysis. Current guidelines consider that surgical reparation is the gold-standard therapy in symptomatic patients with paravalvular leak. However, these recommendations are based in non-randomized observational registries. On the other hand, transcatheter paravalvular leak closure has shown excellent results with a low rate of complications, and nowadays it is considered the first option in selected patients in some experienced centres. In this review, we summarize the clinical manifestations, diagnosis, procedural details, and results of transcatheter mitral PVL closure.
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Affiliation(s)
- Ignacio Cruz-Gonzalez
- Department of Cardiology, University Hospital of Salamanca, 37007 Salamanca, Spain; (I.C.-G.); (S.L.-T.); (P.L.S.)
- Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Pablo Antunez-Muiños
- Department of Cardiology, University Hospital of Salamanca, 37007 Salamanca, Spain; (I.C.-G.); (S.L.-T.); (P.L.S.)
- Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Sergio Lopez-Tejero
- Department of Cardiology, University Hospital of Salamanca, 37007 Salamanca, Spain; (I.C.-G.); (S.L.-T.); (P.L.S.)
- Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Pedro L. Sanchez
- Department of Cardiology, University Hospital of Salamanca, 37007 Salamanca, Spain; (I.C.-G.); (S.L.-T.); (P.L.S.)
- Instituto de Investigación Biomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Espinoza Rueda MA, Alcántara Meléndez MA, González RM, Jiménez Valverde AS, García García J, Rivas Gálvez RE, Esparza TH, Rodríguez G, Sandoval Castillo LD, Merino Rajme JA. Successful Closure of Paravalvular Leak Using Computed Tomography Image Fusion and Planning With 3-Dimensional Printing. JACC Case Rep 2022; 4:36-41. [PMID: 35036941 PMCID: PMC8743814 DOI: 10.1016/j.jaccas.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
The presence of moderate to severe paravalvular leak increases mortality. We present a case of giant paravalvular leak closure using the 3-dimensional printing model to assess the success of the device to be used for its closure, computed tomography was performed for planning and guiding the procedure by image fusion. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Manuel A. Espinoza Rueda
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Marco A. Alcántara Meléndez
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Roberto Muratalla González
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Arnoldo S. Jiménez Valverde
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Juan.F. García García
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Ronald E. Rivas Gálvez
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Tomas Hernández Esparza
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Gustavo Rodríguez
- Department of Echocardiography, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Luz D. Sandoval Castillo
- Department of Cardiovascular Imaging, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - José A. Merino Rajme
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
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12
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Janmohamed IK, Mishra V, Geragotellis A, Sherif M, Harky A. Mitral valve paravalvular leaks: Comprehensive review of literature. J Card Surg 2021; 37:418-430. [PMID: 34822197 DOI: 10.1111/jocs.16145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mitral paravalvular leaks (mPVL) are a recognized complication for patients with mitral valve prostheses. Although clinically insignificant for many patients, it may pose life-threatening haemolysis and regurgitation-induced heart failure, and so clinicians should have a high index of suspicion in the presence of new symptoms. AIMS This review discusses the pathogenesis, clinical features, diagnosis, imaging and treatment of mPVLs. METHODS A comprehensive literature search was performed using PubMed, EMBASE, Cochrane database, Google Scholar and Ovid. Search terms used included "mitral valve paravalvular leak," "transthoracic echocardiography," "2D transoesophageal echocardiography," "3D transoesophageal echocardiography," "cardiac computed tomography," (CT) "cardiac magnetic resonance imaging," "intracardiac echocardiography," "cinefluoroscopy," "fluoroscopy," and "percutaneous closure." RESULTS All patients with mPVLs should undergo regular full evaluation, including patient history, physical examination, laboratory work-up, imaging, and referral, if necessary. Echocardiography is fundamental to the diagnosis, and is augmented with cardiac magnetic resonance imaging, cardiac computerized tomography and fluoroscopy for further characterization and procedural planning amongst the structural heart team. CONCLUSION The prevalence of mPVL is expected to increase proportionally to the growing number of surgical and transcatheter valve replacements conducted in the ageing population. Multimodal imaging is instrumental in guiding diagnostic and therapeutic strategies when managing mPVLs. Advances in imaging and capabilities of transcather devices will prompt growing uptake of percutaneous treatment over conventional, higher-risk surgery for mPVL management.
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Affiliation(s)
| | - Vaibhav Mishra
- St. George's University of London Medical School, Tooting, London, UK
| | - Alexander Geragotellis
- Faculty of Health Sciences, Observatory, University of Cape Town School of Medicine, Cape Town, South Africa
| | - Mohamed Sherif
- Department of Cardiothoracic, Northern General Hospital, Sheffield, UK
| | - Amer Harky
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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13
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Balloon leakage dilation over arterio-aorta rail support greatly facilitates a complex aortic paravalvular leak closure. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:223-225. [PMID: 34400927 PMCID: PMC8356833 DOI: 10.5114/aic.2021.107505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
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14
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Kargoli F, Pagnesi M, Rahgozar K, Goldberg Y, Ho E, Chau M, Colombo A, Latib A. Current Devices and Complications Related to Transcatheter Mitral Valve Replacement: The Bumpy Road to the Top. Front Cardiovasc Med 2021; 8:639058. [PMID: 34179126 PMCID: PMC8230552 DOI: 10.3389/fcvm.2021.639058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Mitral regurgitation is the most common valvular lesion in the developed world, with increasing prevalence, morbidity, and mortality. The experience with surgical mitral valve repair or replacement is very well-validated. However, more than 45% of these patients get denied surgery due to an elevated risk profile and advanced disease of the left ventricle at the time of presentation, promoting the need for less invasive transcatheter options such as transcatheter repair and transcatheter mitral valve replacement (TMVR). Early available TMVR studies have shown promising results, and several dedicated devices are under clinical evaluation. However, TMVR is still in the early developmental stages and is associated with a non-negligible risk of periprocedural and post-procedural complications. In this review, we discuss the current challenges facing TMVR and the potential TMVR-related complications, offering an overview on the measures implemented to mitigate these complications, and future implications.
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Affiliation(s)
- Faraj Kargoli
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Matteo Pagnesi
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Kusha Rahgozar
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ythan Goldberg
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Edwin Ho
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Mei Chau
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
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15
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Oladiran O, Areoye G, Oladunjoye AO, Oladunjoye OO, Elgin E, Licata A. Closure of a Prosthetic Mitral Valve Paravalvular Leak Using a Ventricular Septal Defect (VSD) Amplatzer Occluder Device. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928003. [PMID: 33514683 PMCID: PMC7859888 DOI: 10.12659/ajcr.928003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/18/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Paravalvular leaks (PVL) are becoming more commonly experienced in clinical practice due to the increasing number of mitral valve replacements performed. There are about 182 000 valve replacements performed annually, with a 5-15% prevalence rate of paravalvular leaks. Due to increased mortality associated with surgical repair, percutaneous transcatheter closure procedures are increasingly being performed as an alternative to repeat surgery. CASE REPORT We present the case of a 52-year-old woman with past medical history of mitral valve endocarditis who developed worsening acute heart failure 1 month after surgical bioprosthetic mitral valve replacement. Transesophageal echocardiography at the time revealed dehiscence of the bioprosthetic mitral valve and severe mitral regurgitation. She subsequently had emergent surgical bioprosthetic mitral valve replacement and annular reconstruction. The post-operative course was complicated by increasing dyspnea and lower-extremity edema, with recurrent pericardial tamponade requiring placement of a pericardial window. Based on her multiple comorbidities, most notably the concomitant right ventricular failure with severe pulmonary hypertension and prior pericardial patch repair with compromise of her mitral valve annulus, she was deemed inoperable for re-do surgery and eventually underwent a successful percutaneous closure of the mitral paravalvular leak with a ventricular septal defect (VSD) Amplatzer occluder device. The patient made good recovery and was discharged home a few days after the procedure. CONCLUSIONS Although use of the Amplatzer VSD occluder device for this indication currently remains off-label, our report supports the use of the VSD occluder device in this subset of patients considering the high mortality rates associated with repeat surgical procedure.
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Affiliation(s)
- Oreoluwa Oladiran
- Cardiovascular Division, Reading Hospital – Tower Health, West Reading, PA, U.S.A
| | - Gabriel Areoye
- Department of Internal Medicine, Reading Hospital – Tower Health, West Reading, PA, U.S.A
| | - Adeolu O. Oladunjoye
- Division of Medical Critical Care, Boston Children’s Hospital, Boston, MA, U.S.A
| | - Olubunmi O. Oladunjoye
- Department of Internal Medicine, Reading Hospital – Tower Health, West Reading, PA, U.S.A
| | - Eric Elgin
- Cardiovascular Division, Reading Hospital – Tower Health, West Reading, PA, U.S.A
| | - Anthony Licata
- Cardiovascular Division, Reading Hospital – Tower Health, West Reading, PA, U.S.A
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16
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Khan K, Taweesedt PT, Venkatachalam S, Surani S. A Complicated Case of a Paravalvular Leak Following Mitral Valve Replacement. Cureus 2020; 12:e11897. [PMID: 33415049 PMCID: PMC7781868 DOI: 10.7759/cureus.11897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Paravalvular leaks (PVL) are an uncommon sequelae of valve replacement but can be seen as a complication of both mechanic and prosthetic valves. Patients with PVL may remain asymptomatic or have detrimental complications, which include heart failure, hemodynamically significant hemolysis, and endocarditis. Management depends on the clinical presentation and the degree of the valvular leak. We hereby present a case report of a patient with a complicated clinical course secondary to a PVL of the mitral valve. The patient had a recent mitral valve replacement and presented with symptoms of heart failure that was refractory to standard medical therapy. Valvular abnormality was not seen with initial trans-thoracic echocardiogram (TTE), but with high clinical suspicion, a trans-esophageal echocardiogram (TEE) was done confirming a PVL. The patient’s condition continued to deteriorate; he became hemodynamically unstable with end-organ damage. Cardiothoracic surgery was consulted for surgical repair of the PVL. The patient, however, remained too unstable for surgery and the family opted for comfort measures per the patient’s wishes.
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Affiliation(s)
- Kashmala Khan
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | | | | | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
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17
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ElGuindy A, Osman A, Elborae A, Nagy M. The utility of 3D printed models in complex percutaneous paravalvular leak interventions. Glob Cardiol Sci Pract 2020; 2020:e202027. [PMID: 33426044 PMCID: PMC7768626 DOI: 10.21542/gcsp.2020.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Paravalvular leaks (PVL) are seen in 5–17% of patients after surgical mitral and aortic valve replacement. This is usually well-tolerated in the majority of patients; however, up to 5% will require re-intervention due to either hemodynamically significant regurgitation or hemolysis requiring repeated blood transfusion. Transcatheter closure of PVLs is becoming the treatment of choice in many patients owing to the high risk of redo surgery, high rates of recurrence with the surgical approach, and substantial improvements in device technology and growing expertise in structural heart disease interventions. Careful selection of the appropriate candidates by the Heart Team with in-depth analysis of clinical and multimodality imaging data is critical to ensuring good short- and long-term outcomes1. The defect is usually oval/crescentic and often serpiginous in nature, which poses significant challenges in choosing the optimal size and number of devices to implant - especially with large size defects. Generally, defects involving more than 25–30% of the sewing ring are deemed unsuitable for percutaneous closure. While the Amplatzer family of vascular plugs (e.g. AVP3 and AVP2) is commonly used for percutaneous closure of PVLs, there are currently no approved dedicated devices for this indication, except the paravalvular leak device (Occlutech) which is not universally available. Small and relatively circular defects can usually be closed using a single plug, conventionally utilizing a size that is 25–30% larger than the mean diameter of the defect. Larger and crescentic defects on the other hand frequently require more than one plug and can be quite challenging in terms of choosing the appropriate size(s)2. We report two cases with very large defects with irregular shape in which 3D printed modeling was extremely useful for bench testing to optimize the number and sizes of devices to be implanted.
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Affiliation(s)
| | - Ahmed Osman
- Aswan Heart Centre, Aswan, Egypt.,Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Elborae
- Aswan Heart Centre, Aswan, Egypt.,Faculty of Medicine, Cairo University, Egypt
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18
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Abuelatta R, Khedr L, AlHarbi I, Naeim HA. Management of severe haemolytic anaemia due to residual small mitral paravalvular leak post-percutaneous closure: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33073168 PMCID: PMC7543880 DOI: 10.1093/ehjcr/ytaa101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/20/2019] [Accepted: 04/01/2020] [Indexed: 11/12/2022]
Abstract
Background Haemolytic anaemia is a complication of paravalvular leak (PVL). The correlation between the size of the leak and the severity of haemolysis is unclear. Small leaks can cause severe haemolysis, whereas significant leaks may cause no haemolysis. Case summary We report the case of a 40-year-old male who underwent mechanical mitral and aortic valve replacement 20 years ago. In the last 3 years, the procedure was repeated three times due to infective endocarditis. He presented with severe shortness of breath. A transoesophageal echocardiogram with three-dimensional surgical view showed that both discs of the mechanical mitral valve opened sufficiently but a severe PVL had occurred at the 9-12 o'clock position. The location of the mitral valve was abnormal, the sewing ring was inserted high at the mid-interatrial septum. The mechanical aortic valve functioned well. Closure of the transcutaneous PVL was accomplished with two percutaneously implanted devices, leaving a small leak in between. After closure, he developed haemolytic anaemia (haemoglobin: 6 g/dL, lactate dehydrogenase: 1896 units/L, reticulocyte count: 4.6%). He then received 16 units of packed red blood cells. He developed acute kidney injury and was started on haemodialysis. We then installed two additional devices to completely close the mild residual leak and another device to resolve the bidirectional transseptal defect. After 2 days, his renal function returned to normal and anaemia improved (haemoglobin: 9.1 g/dL). Discussion Mild residual paravalvular leak can cause severe haemolytic anaemia that is correctable via percutaneous closure of the leak.
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Affiliation(s)
- Reda Abuelatta
- Madina Cardiac Center, Khaled Bin Waleed Street, 42311-6167 Madina, Saudi Arabia
| | - Lamiaa Khedr
- Madina Cardiac Center, Khaled Bin Waleed Street, 42311-6167 Madina, Saudi Arabia
| | - Ibraheem AlHarbi
- Madina Cardiac Center, Khaled Bin Waleed Street, 42311-6167 Madina, Saudi Arabia
| | - Hesham A Naeim
- Madina Cardiac Center, Khaled Bin Waleed Street, 42311-6167 Madina, Saudi Arabia
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19
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Onorato EM, Muratori M, Smolka G, Malczewska M, Zorinas A, Zakarkaite D, Mussayev A, Christos CP, Bauer F, Gandet T, Martinelli GL, Costante AM, Bartorelli AL. Midterm procedural and clinical outcomes of percutaneous paravalvular leak closure with the Occlutech Paravalvular Leak Device. EUROINTERVENTION 2020; 15:1251-1259. [DOI: 10.4244/eij-d-19-00517] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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20
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Abordaje percutáneo de las dehiscencias paravalvulares: alternativa a la cirugía o primera opción terapéutica. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Abstract
Paravalvular leak (PVL) is a complication that occurs in 5-17% of patients after surgical prosthetic valve implantation. Whereas PVLs can be benign, some PVLs are associated with substantial morbidity and mortality. Percutaneous closure using occluders specifically designed to improve closure and reduce procedural complications has now become the first-line treatment for PVL. In this Review, we first detail the frequency and clinical consequences of PVL closure. The role of cardiac imaging in the assessment and management of PVL, including echocardiographic imaging and adjunctive techniques such as CT, is then discussed, together with important considerations for the percutaneous closure of PVL, such as access site and device selection. Finally, we summarize the clinical evidence for percutaneous closure of PVL, including large national registries from Ireland, Spain and the UK, as well as head-to-head data comparing this procedure with surgical closure.
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Affiliation(s)
- Joel P Giblett
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Bushra S Rana
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Leonard M Shapiro
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK. .,Department of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
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22
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Vrachatis DA, Vavuranakis M, Tsoukala S, Giotaki S, Papaioannou TG, Siasos G, Deftereos G, Giannopoulos G, Raisakis K, Tousoulis D, Deftereos S, Vavuranakis M. "TAVI: Valve in valve. A new field for structuralists? Literature review". Hellenic J Cardiol 2019; 61:148-153. [PMID: 31809790 DOI: 10.1016/j.hjc.2019.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/23/2019] [Accepted: 10/16/2019] [Indexed: 12/30/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) led to the foundation of the subspecialty of structural heart interventions and created an emerging area of clinical and technical issues. Soon after TAVI introduction into clinical practice, boundaries were expanded with utilization of valve-in-valve (V-i-V) techniques. V-i-V comprised a diverse subset of patients including TAVI within TAVI, TAVI within a degenerated surgically implanted bioprosthesis, or even TAVI-in-TAVI-in-surgical bioprosthesis. In the present review, we summarize the available literature and present initial experience on the field in Greece.
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Affiliation(s)
- Dimitrios A Vrachatis
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece.
| | - Michail Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Tsoukala
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | | | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Georgios Giannopoulos
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Konstantinos Raisakis
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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23
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Gérardin B, Champagnac D, Smolka G, Bouvaist H, Jakamy R, Ghostine S, Naël J, Garcia C, Kloeckner M, Potier A, Isorni MA, Brenot P, Hascoet S. [Para valvular leak closure in TAVI]. Ann Cardiol Angeiol (Paris) 2019; 68:453-461. [PMID: 31733689 DOI: 10.1016/j.ancard.2019.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017-2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one-who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI » procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.
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Affiliation(s)
- B Gérardin
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | | | - G Smolka
- Medical University of Silesia, 40055 Katowice, Pologne
| | - H Bouvaist
- Centre hospitalo-universitaire de Grenoble, 38700 La-Tronche, France
| | - R Jakamy
- Centre hospitalo universitaire Haut-Lévêque, 33600 Pessac, France
| | - S Ghostine
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - J Naël
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - C Garcia
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - M Kloeckner
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - A Potier
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - M A Isorni
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - P Brenot
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
| | - S Hascoet
- Hôpital Marie-Lannelongue, Le-Plessis-Robinson, 92350 France
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24
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Millán X, Li CH, Arzamendi D. Percutaneous management of paravalvular leaks: an alternative to surgery or first-line therapy. ACTA ACUST UNITED AC 2019; 73:110-113. [PMID: 31708449 DOI: 10.1016/j.rec.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Chi-Hion Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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25
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Rajiah P, Moore A, Saboo S, Goerne H, Ranganath P, MacNamara J, Joshi P, Abbara S. Multimodality Imaging of Complications of Cardiac Valve Surgeries. Radiographics 2019; 39:932-956. [PMID: 31150303 DOI: 10.1148/rg.2019180177] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Replacement with a prosthetic heart valve (PHV) remains the definitive surgical procedure for management of severe cardiac valve disease. PHV dysfunction is uncommon but can be a life-threatening condition. The broad hemodynamic and pathophysiologic manifestations of PHV dysfunction are stenosis, regurgitation, and a stuck leaflet. Specific structural abnormalities that cause PHV dysfunction include prosthetic valve-patient mismatch, structural failure, valve calcification, dehiscence, paravalvular leak, infective endocarditis, abscess, pseudoaneurysm, abnormal connections, thrombus, hypoattenuating leaflet thickening, and pannus. Multiple imaging modalities are available for evaluating a PHV and its dysfunction. Transthoracic echocardiography is often the first-line imaging modality, with additional modalities such as transesophageal echocardiography, CT, MRI, cine fluoroscopy, and nuclear medicine used for further characterization and establishing a specific cause. The authors review PHVs and the role of imaging modalities in evaluation of PHV dysfunction and illustrate the imaging appearances of different complications. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Alastair Moore
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Sachin Saboo
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - James MacNamara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Parag Joshi
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
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26
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Kim BH, Koh YS, Lee KY, Chung WB. Three-dimensional EchoNavigator System Guided Transcatheter Closure of Paravalvular Leakage. J Cardiovasc Imaging 2019; 27:227-229. [PMID: 31161754 PMCID: PMC6669176 DOI: 10.4250/jcvi.2019.27.e30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/17/2019] [Accepted: 05/07/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Byung Ho Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Seok Koh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwan-Yong Lee
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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27
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Mahmood F, Gao Z, Bortman JM. The Sign of Things to Come: Who Calls the Shots? J Cardiothorac Vasc Anesth 2018. [PMID: 29525192 DOI: 10.1053/j.jvca.2018.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Zhifeng Gao
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Jeffrey M Bortman
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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28
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Closure of mitral paravalvular defects without performing an arteriovenous loop: a case series of fourteen patients. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 13:307-312. [PMID: 29362573 PMCID: PMC5770861 DOI: 10.5114/aic.2017.71612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/28/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction The arteriovenous (AV) loop is recommended when further support is needed during paravalvular leak (PVL) closure. Aim We report the feasibility and safety of mitral PVL closure without constructing an AV loop, based on a single-centre experience. Material and methods Fourteen patients with mitral valve replacement (MVR) who had New York Heart Association (NYHA) class III-IV dyspnoea or NYHA class II symptoms with significant haemolytic anaemia caused by severe or moderate-to-severe paravalvular regurgitation and who underwent transcatheter PVL closure (TPVLC) between May 2014 and February 2017 were enrolled. Results In total, 15 PVL procedures and 19 device deployments were performed. The patients had one (n = 10), three (n = 1) or four (n = 1) devices for closure at the time of the procedure; one patient had two devices from two procedures at different times with different access ways. Nineteen devices (10 (66.6%) via transseptal access; 4 (26.6%), transapical access; and 1 (6.6%), retrograde access) were deployed successfully without making an AV loop. Conclusions The TPVLC is a less invasive and effective alternative to surgery in symptomatic patients with significant PVLs and high operational risks. The success rates are satisfactory, with improving techniques and devices. Procedural success without using an AV loop can be achieved with reduced costs, fluoroscopic times and complications.
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29
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Saitto G, Nardi P, Ussia GP, Sergi D, Prati P, Russo M, Romeo F, Ruvolo G. Percutaneous aortic leak closure in a small and frail annulus after double heart valve replacement. J Cardiovasc Med (Hagerstown) 2017; 18:916-919. [PMID: 28914661 DOI: 10.2459/jcm.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Paravalvular leak (PVL) is an uncommon but serious complication associated with the implantation of prosthetic valves. Following aortic valve replacement, up to 5% of patients affected by PVL develop clinical symptoms of heart failure, hemolysis or both. Percutaneous treatment of PVL has emerged instead of conventional surgery, as a well tolerated and less invasive procedure but remains a challenge. We present the case of a young woman with mechanical aortic and mitral prostheses, who presented surgical aortic PVL caused by a serious frailty of native annulus, became symptomatic after 5 months and was successfully percutaneously treated with an Amplatzer Duct Occluder device.
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Affiliation(s)
- Guglielmo Saitto
- aCardiac Surgery Unit bCardiology Unit cCardiac Anesthesia Division, Tor Vergata University Policlinic, Rome, Italy
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