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Huang L, Mahmood F, Laham R, Sharma RK, Belani K. Percutaneous Approach to Mechanical Aortic Valve Prosthesis Paravalvular Leak Closure: Lessons Learned. J Cardiothorac Vasc Anesth 2024; 38:1203-1210. [PMID: 38423882 DOI: 10.1053/j.jvca.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Lisa Huang
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH.
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Roger Laham
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ravi K Sharma
- Jewish Hospital Cardiology, University of Louisville Jewish Hospital, Louisville, KY
| | - Kiran Belani
- Department of Anesthesiology, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL
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Helmy T, Kumar S, Khan AA, Raza A, Smart S, Bailey SR. Review of Prosthetic Paravalvular Leaks: Diagnosis and Management. Curr Cardiol Rep 2022; 24:1287-1297. [PMID: 36152141 DOI: 10.1007/s11886-022-01744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Paravalvular leak (PVL) is a relatively uncommon complication associated with prosthetic valve implantation. PVL can occasionally lead to serious adverse consequences such as congestive heart failure, infective endocarditis, and hemolytic anemia. Surgical re-operation carries a high mortality risk. RECENT FINDINGS Transcatheter closure therapy provides a viable alternative for the treatment of this disorder with reasonable procedural and clinical success. The recent advent of hybrid imaging modalities has increased procedural success. This article summarizes the pathophysiology, clinical characteristics, and treatment modalities surroundings prosthetic paravalvular leak.
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Affiliation(s)
- Tarek Helmy
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA.
| | - Sundeep Kumar
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Abdul A Khan
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Ali Raza
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Steven Smart
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Steven R Bailey
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA
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Wojtas K, Kozłowski M, Orciuch W, Makowski Ł. Computational Fluid Dynamics Simulations of Mitral Paravalvular Leaks in Human Heart. MATERIALS 2021; 14:ma14237354. [PMID: 34885504 PMCID: PMC8658524 DOI: 10.3390/ma14237354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/21/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
In recent years, computational fluid dynamics (CFD) has been extensively used in biomedical research on heart diseases due to its non-invasiveness and relative ease of use in predicting flow patterns inside the cardiovascular system. In this study, a modeling approach involving CFD simulations was employed to study hemodynamics inside the left ventricle (LV) of a human heart affected by a mitral paravalvular leak (PVL). A simplified LV geometry with four PVL variants that varied in shape and size was studied. Predicted blood flow parameters, mainly velocity and shear stress distributions, were used as indicators of how presence of PVLs correlates with risk and severity of hemolysis. The calculations performed in the study showed a high risk of hemolysis in all analyzed cases, with the maximum shear stress values considerably exceeding the safe level of 300 Pa. Results of our study indicated that there was no simple relationship between PVL geometry and the risk of hemolysis. Two factors that potentially played a role in hemolysis severity, namely erythrocyte exposure time and the volume of fluid in which shear stress exceeded a critical value, were not directly proportional to any of the characteristic geometrical parameters (shape, diameters, circumference, area, volume) of the PVL channel. Potential limitations of the proposed simplified approach of flow analysis are discussed, and possible modifications to increase the accuracy and plausibility of the results are presented.
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Affiliation(s)
- Krzysztof Wojtas
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland; (W.O.); (Ł.M.)
- Correspondence: ; Tel.: +48-22-234-6275
| | - Michał Kozłowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45/47, 40-635 Katowice, Poland;
| | - Wojciech Orciuch
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland; (W.O.); (Ł.M.)
| | - Łukasz Makowski
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warynskiego 1, 00-645 Warsaw, Poland; (W.O.); (Ł.M.)
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Abstract
PURPOSE OF REVIEW Given the low occurrence of clinically important paravalvular leak (PVL), there are no large registries or trials in this space to investigate management strategies. This review integrates newer evidence, particularly in imaging guidance for these complex procedures, novel techniques and approaches that our group has taken, as well as approaches to more complex PVL plugging reported in case reports. RECENT FINDINGS Perhaps the largest area of growth in the management of PVL is the use of advanced imaging in both pre-procedure evaluation and intra-procedural guidance with gated cardiac CT, 3D TEE, and fluoroscopy fusion technologies. Outside the USA, a new device, the Occlutech PLD, has become available with early data indicating high success rates. There remains little randomized data to support the efficacy of percutaneous PVL closure. Gated cardiac CT has become key to the pre-procedure evaluation for transcatheter closure as it allows for increased procedural efficiency and more accurate pre-procedure planning, particularly when combined with 3D printing. Intra-procedural TEE-fluoro fusion allows for more rapid crossing of defects by providing a visual target for interventionalists. The advent of purpose-built devices for PVL closure may further increase the efficacy and efficiency of percutaneous closure, but significant barriers remain for approval of these devices in the USA.
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Affiliation(s)
- Aken Desai
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA.
| | - John C Messenger
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
| | - Robert Quaife
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
| | - John Carroll
- Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz School of Medicine, 12401 E. 17th Ave, Leprino Building, Room 511, Mail Stop B132, Aurora, CO, 80045, USA
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Intraprocedural cardiac complications of transcatheter aortic and mitral valve interventions: "The eyes do not see what the mind does not know". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:144-152. [PMID: 34053872 DOI: 10.1016/j.carrev.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 11/20/2022]
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Paravalvular leak closure: Still a challenge with unpredictable results. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Galrinho A, Branco LM, Fiarresga A, Cacela D, Sousa L, Ramos R, Ferreira RC. Paravalvular leak closure: Still a challenge with unpredictable results. Rev Port Cardiol 2021; 40:261-269. [PMID: 33648808 DOI: 10.1016/j.repc.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Paravalvular leak (PVL) is a common serious complication associated with prosthetic valve implantation. OBJECTIVE The aim of this study was to report our single-center experience in a retrospective review and to analyze possible predictors of success. METHODS We performed 33 percutaneous PVL closures in 26 patients (54% female, mean age 65±13 years). All mitral prostheses were studied previously with 3D transesophageal echocardiography (TEE), and aortic prostheses with 2D/3D TEE. 3D TEE and fluoroscopy were used for the assessment, planning, and guidance of the interventions. Twelve patients also underwent computed tomography angiography for better characterization of anatomic details. RESULTS Eighteen patients (69.2%) were admitted due to heart failure (New York Heart Association [NYHA] III or IV, seven (26.9%) because of heart failure and hemolysis, and one (3.8%) due to hemolysis only. Regarding the leaks, 46.2% were in aortic and 53.8% in mitral prostheses, 88.5% in mechanical and 7.7% in biological prostheses, and 3.8% in transcatheter aortic valve implants. All the aortic patients had severe aortic regurgitation. Furthermore, all mitral patients but one had moderate to severe or severe mitral regurgitation. Closure was successful in 17 patients (65.4%), partially successful in four (15.4%) and unsuccessful in five (19.2%). After the procedure, 69% were in NYHA I-II. Hemolysis worsened in three patients despite successful closure; all required further valvular surgery and two died. Regarding angiographic and echocardiographic procedural success, we analyzed age, gender, type of prosthesis (mechanical or biological), location (aortic or mitral), clinical data, maximum leak diameter, anatomic regurgitant orifice, leak location (anterior, posterior, inferior and lateral for mitral leaks and left, right and non-coronary sinus for aortic leaks), and number of devices (plugs) used for closure. No parameters presented a significant relationship with success excepting previous hemolysis. There was a relationship between clinical improvement and reduction of PVL (p=0.0001). In follow-up, cardiac-related events (new hospital admissions, cardiac valvular surgery, need for transfusion) were more frequent in patients with partially successful or unsuccessful closure (p=0.012). There was a relationship between cardiac-related events and death (p=0.029). CONCLUSION Percutaneous PVL closure has emerged as an alternative treatment for PVL. Predictors of procedural success are difficult to establish. Survival is related to reduction of regurgitation and improvement in NYHA functional class.
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Trivedi DP, Chigarapalli SR, Gangahar DM, Machiraju VR. The impact of advances in percutaneous catheter interventions on redo cardiac surgery. Indian J Thorac Cardiovasc Surg 2021; 37:61-69. [PMID: 33442208 PMCID: PMC7778657 DOI: 10.1007/s12055-020-01029-5] [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: 05/18/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
Toward the end of the twentieth century, redo cardiac surgery accounted for approximately 15-20% of total cardiac surgical volume. Major risk factors for redo cardiac surgery include young age at time of the first operation, progression of native coronary artery disease (CAD), vein graft atherosclerosis, bioprosthetic valve failure and endocarditis, and transplantation for end stage heart failure. Historically, redo coronary artery bypass grafting (CABG) alone carried a mortality risk of around 4%. Factors such as older age, female sex, comorbidities, combined procedures, hemodynamic instability, and emergency procedures contributed to even higher mortality and morbidity. These poor outcomes made it necessary to look for less invasive alternate methods of treatment. Advances in catheter-based interventions have made a major impact on redo cardiac surgeries, making it no longer the first option in a majority of cases. Percutaneous interventions for recurrence following CABG, transcutaneous aortic valve replacement (TAVR) for calcific aortic stenosis, valve in valve (VIV) implantations, device closure of paravalvular leaks (PVL), and thoracic endovascular aortic repair (TEVAR) for residual and recurrent aneurysms and mitral clip to correct mitral regurgitation (MR) in heart failure are rapidly developing or developed, obviating the need for redo cardiac surgery. Our intent is to review these advances and their impact on redo cardiac surgery.
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Affiliation(s)
- Dhaval Pravin Trivedi
- Department of Cardiothoracic Surgery, Los Angeles Medical Center, Kaiser Permanente, Los Angeles, CA USA
| | - SukeshKumar Reddy Chigarapalli
- Department of Cardiothoracic Surgery, Asian Institute of Gastroenterology Hospitals, Gachibowli, Hyderabad, TG 500031 India
| | - Deepak Mohan Gangahar
- Department of Thoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
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Mahmoud-Elsayed H. Added value of three-dimensional transesophageal echocardiography in management of mitral paravalvular leaks. Echocardiography 2020; 37:954-964. [PMID: 32449807 DOI: 10.1111/echo.14708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/19/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022] Open
Abstract
Prosthetic paravalvular leak (PVL) is a well-known serious complication following surgically as well as percutaneously implanted prosthetic valves. It usually happens due to incomplete sealing of the prosthetic ring to the native cardiac tissue whether immediately postoperative or considerably later as a complication of infective endocarditis, etc Surgery has been always the treatment of choice for clinically significant PVLs. However, percutaneous transcatheter closure therapy has become a successful alternative in carefully selected group of patients. Echocardiography is a cornerstone in the initial diagnosis, assessment of the severity and location of the PVL. Furthermore, it plays a crucial role in the assessment of the feasibility for percutaneous closure and during intra-procedural guidance. Transesophageal echocardiography (TEE) has the advantage over transthoracic echocardiography (TTE) of not being affected by the acoustic shadow of the mitral prosthesis that usually hides the regurgitation jets and makes TTE evaluation difficult. Three-dimensional (3D) TEE has been shown to provide better diagnostic accuracy compared to two-dimensional (2D) TEE as regard to evaluation of PVLs especially in patients with more than one PVL. This is due to better delineation of the location, shape, and size of the PVL and equally important during guiding the transcatheter percutaneous closure.
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Affiliation(s)
- Hani Mahmoud-Elsayed
- CardioVascular Imaging/Cardiology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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10
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Okutucu S, Mach M, Oto A. Mitral Paravalvular Leak Closure: Transcatheter and Surgical Solutions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:422-431. [DOI: 10.1016/j.carrev.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW As the number of surgical and transcatheter valve replacements continue to increase in the aging population, so does the incidence of paravalvular leak (PVL). Given its impact on morbidity and mortality, this article will focus on the epidemiology, clinical presentation, diagnostic assessment, and available treatments for PVL. RECENT FINDINGS Despite being performed on inoperable and typically higher risk patients, short-term complication rates of transcatheter PVL closure appear relatively low (< 10%). When indirectly compared with surgical PVL closure, long-term mortality, reoperation rates and degree of symptom improvement are similar. Nonetheless, current transcatheter closure devices are off-label and repurposed from other indications. Further development of percutaneous closure devices is an essential next step in order to improve and optimize outcomes. In patients with surgical and especially transcatheter-replaced heart valves, clinicians need to maintain vigilance for the presence of PVL, particularly in those with new-onset heart failure or hemolysis. Multimodality imaging is essential to detect and quantify PVL. Echocardiography (both transthoracic and transesophageal) is the backbone of diagnosis and quantification, and cardiac computed tomography and cardiac magnetic resonance imaging play an important role in defect characterization and in periprocedural planning. For those patients who are unable to undergo surgery, transcatheter PVL closure is an appropriate next step in management as it has similar outcomes to surgical intervention when performed in a center of expertise.
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Celik M, Yuksel UC. Percutaneous transapical closure of paravalvular leak in bioprosthetic mitral valve without radio-opaque indicators. Cardiovasc Diagn Ther 2019; 9:60-63. [PMID: 30881879 DOI: 10.21037/cdt.2018.10.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Placement of radio-opaque indicators in coronary sinus and aortic non-coronary cusp can help to describe the mitral valve contours fluoroscopically during percutaneous transcatheter closure of paravalvular leak (PVL) in invisible mitral valve bioprosthesis.
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Affiliation(s)
- Murat Celik
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Cagdas Yuksel
- Department of Cardiology, Gulhane Training and Research Hospital, Ankara, Turkey
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13
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Cubeddu RJ, Crespo HJ, Novaro GM. Retrograde transmitral paravalvular leak closure through an antegrade transseptal approach: A novel technique. Catheter Cardiovasc Interv 2018; 92:1196-1200. [PMID: 29330899 DOI: 10.1002/ccd.27482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/17/2017] [Indexed: 11/06/2022]
Abstract
Mitral paravalvular leak (PVL) remains a well-known complication after mitral valve replacement. Since the first report over 25 years ago, several catheter-based PVL closure techniques have been described. Most of these comprise of either an antegrade transseptal approach, or a retrograde transaortic or transapical approach. We herein report a novel percutaneous mitral PVL closure technique that was safely and successfully performed after failed attempt using a conventional antegrade approach.
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Affiliation(s)
| | - Hector J Crespo
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
| | - Gian M Novaro
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
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Joseph TA, Lane CE, Fender EA, Zack CJ, Rihal CS. Catheter-based closure of aortic and mitral paravalvular leaks: existing techniques and new frontiers. Expert Rev Med Devices 2018; 15:653-663. [DOI: 10.1080/17434440.2018.1514257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Timothy A. Joseph
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Colleen E. Lane
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erin A. Fender
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chad J. Zack
- Department of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Charanjit S. Rihal
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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Mitrev L, Desai N, Awad A, Sabir S. Interventional Echocardiography of the MV: What the Interventionalist Wants to Know. Semin Cardiothorac Vasc Anesth 2018; 23:37-47. [PMID: 29897008 DOI: 10.1177/1089253218778822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The past 2 decades have seen a proliferation of transcatheter mitral valve (MV) therapies, which are less invasive and distinct from surgical MV repair or replacement. The commonly used MV transcatheter therapies include (1) percutaneous mitral balloon commissurotomy (PMBC) for rheumatic mitral stenosis; (2) edge-to-edge repair with the MitraClip for mitral regurgitation; (3) valve-in-valve implantation in bioprosthetic MV, native MV, or mitral ring; and (4) closure of paravalvular leaks (PVLs). This article will focus on the use of echocardiography in the diagnosis, patient selection, procedural guidance, and postprocedural follow-up for PMBC, with notes on the role of transesophageal echocardiography in transcatheter interventions for prosthetic valve degeneration and PVL closure.
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Affiliation(s)
| | - Nayan Desai
- 1 Cooper University Hospital, Camden, NJ, USA
| | - Ahmed Awad
- 1 Cooper University Hospital, Camden, NJ, USA
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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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Peñalver J, Shatila W, Silva GV. Percutaneous Closure of 2 Paravalvular Leaks and a Gerbode Defect after Mitral Valve Replacement for Infective Endocarditis. Tex Heart Inst J 2017; 44:153-156. [PMID: 28461806 DOI: 10.14503/thij-16-5996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Surgical valve replacement after infective endocarditis can result in local destructive paravalvular lesions. A 30-year-old woman with infective endocarditis underwent mitral valve replacement that was complicated postoperatively by 2 paravalvular leaks. During percutaneous closure of the leaks, a Gerbode defect was also found and closed. We discuss our patient's case and its relation to others in the relevant medical literature. To our knowledge, we are the first to describe the use of a percutaneous approach to close concomitant paravalvular leaks and a Gerbode defect.
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Buck T, Bösche L, Plicht B. [Real-time 3D echocardiography for estimation of severity in valvular heart disease : Impact on current guidelines]. Herz 2017; 42:241-254. [PMID: 28229203 DOI: 10.1007/s00059-017-4540-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Besides providing spatial anatomic information on heart valves, real-time three-dimensional echocardiography (3DE) combined with color Doppler has the potential to overcome the limitations of flow quantification inherent to conventional 2D color Doppler methods. Recent studies validated the application of color Doppler 3DE (cD-3DE) for the quantification of regurgitation flow based on the vena contracta area (VCA) and the proximal isovelocity surface area (PISA) methods. Particularly the assessment of VCA by cD-3DE led to a change of paradigm by understanding of the VCA as being strongly asymmetric in the majority of patients and etiologies. This review provides a comprehensive description of the different concepts of cD-3DE-based flow quantification in the setting of different valvular heart diseases and their presentation in recent guidelines.
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Affiliation(s)
- T Buck
- Medizinische Klinik III, Klinik für Kardiologie, Klinikum Westfalen, Am Knappschaftskrankenhaus 1, 44309, Dortmund, Deutschland.
| | - L Bösche
- Medizinische Universitätsklinik II - Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - B Plicht
- Medizinische Klinik III, Klinik für Kardiologie, Klinikum Westfalen, Am Knappschaftskrankenhaus 1, 44309, Dortmund, Deutschland
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. Eur Heart J 2017; 39:1224-1245. [DOI: 10.1093/eurheartj/ehx211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Carlos E Ruiz
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | - Rebecca T Hahn
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey S Borer
- State University of New York Downstate Medical Center and College of Medicine, New York, New York
| | | | - Greg Fontana
- Cedars Sinai Medical Center, Los Angeles, California
| | | | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vladimir Jelnin
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | | | | | - Chad Kliger
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Itzhak Kronzon
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Nataf
- AP-HP Hôpital Bichat Service de Cardiologie, Paris, France
| | | | | | | | | | | | - Paul Sorajja
- Minneapolis Heart Institute and Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Zoltan G Turi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. J Am Coll Cardiol 2017; 69:2067-2087. [DOI: 10.1016/j.jacc.2017.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023]
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21
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Maslow A, Szymanski T, Mahmood F. Three-Dimensional Echocardiographic Assessment of a Paravalvular Leak. J Cardiothorac Vasc Anesth 2016; 31:1308-1311. [PMID: 27939193 DOI: 10.1053/j.jvca.2016.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Needham, MA.
| | - Trevor Szymanski
- Department of Anesthesiology, Rhode Island Hospital, Needham, MA
| | - Feroze Mahmood
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA
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22
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Bedair R, Morgan G, Bapat V, Kapetanakis S, Goreczny S, Simpson J, Qureshi S. Early experience with the Occlutech PLD occluder for mitral paravalvar leak closure through a hybrid transapical approach. EUROINTERVENTION 2016; 12:e1420-e1427. [DOI: 10.4244/eijy15m12_07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Alkhouli M, Sarraf M, Maor E, Sanon S, Cabalka A, Eleid MF, Hagler DJ, Pollak P, Reeder G, Rihal CS. Techniques and Outcomes of Percutaneous Aortic Paravalvular Leak Closure. JACC Cardiovasc Interv 2016; 9:2416-2426. [DOI: 10.1016/j.jcin.2016.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
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Abstract
Transcatheter aortic valve replacement for treatment of aortic stenosis has now become an accepted alternative to surgical valve replacement for some patients. In addition, transcatheter mitral valve repair is also routinely used in high surgical risk patients with mitral regurgitation. Other transcatheter procedures are in rapid development. The current review attempts to summarize the procedures and echocardiographic imaging used for transcatheter valve replacement or valve repair.
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Affiliation(s)
- Rebecca T. Hahn
- From the Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY
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Yildirim A, Goktekin O, Gorgulu S, Norgaz T, Akkaya E, Aydin U, Unal Aksu H, Bakir I. A New Specific Device in Transcatheter Prosthetic Paravalvular Leak Closure: A Prospective Two-Center Trial. Catheter Cardiovasc Interv 2016; 88:618-624. [DOI: 10.1002/ccd.26439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/04/2016] [Accepted: 01/09/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Aydin Yildirim
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Omer Goktekin
- Cardiology Department; Bezmialem University Medical Faculty; Istanbul, Turkey
| | - Sevket Gorgulu
- Cardiology Department; Acibadem University Medical Faculty; Istanbul Turkey
| | - Tugrul Norgaz
- Cardiology Department; Acibadem University Medical Faculty; Istanbul Turkey
| | - Emre Akkaya
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Unal Aydin
- Cardiovascular Surgery Department; Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Hale Unal Aksu
- Cardiology Department; Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
| | - Ihsan Bakir
- Cardiovascular Surgery Department; Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital; Istanbul Turkey
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Hagler DJ. Percutaneous paravalvular leak closure? Perhaps a glimmer of hope after a long course of marginal success. EUROINTERVENTION 2016; 11:1095-6. [PMID: 26897288 DOI: 10.4244/eijv11i10a222] [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: 11/23/2022]
Affiliation(s)
- Donald J Hagler
- Divisions of Pediatric Cardiology and Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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Percutaneous transcatheter closure of mitral paravalvular leak via transarterial retrograde approach. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 12:683-6. [PMID: 26788047 PMCID: PMC4712376 DOI: 10.11909/j.issn.1671-5411.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Repeat surgery has usually been considered the first choice to solve paravalvular leaks of prosthetic valves, but it carries a high operative risk, a high mortality rate and an increased risk for re-leaks. Percutaneous closure of such defects is possible, and different approaches and devices are used for this purpose. For mitral paravalvular leaks, constructing an arterio-venous wire loop for delivering the closure device through an antegrade approach is the most commonly used technique. Transcatheter closure can also be performed through a transapical approach or retrograde transfemoral arterial approach. We present a case of 68-year-old man with a mitral paravalvular leak that was successfully closed using an Amplatzer® Duct Occluder II, via retrograde transfemoral arterial approach under three-dimensional transesophageal echocardiographic guidance, without the use of a wire loop. The initial attempt to cross the paravalvular defect was unsuccessful, but the obstacle was finally overcome by introducing complex interventional techniques.
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28
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Burriesci G, Peruzzo P, Susin FM, Tarantini G, Colli A. In vitro hemodynamic testing of Amplatzer plugs for paravalvular leak occlusion after transcatheter aortic valve implantation. Int J Cardiol 2015; 203:1093-9. [PMID: 26642371 DOI: 10.1016/j.ijcard.2015.11.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/04/2015] [Accepted: 11/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to in-vitro test Amplatzer devices (Amplatzer Vascular Plug II and Amplatzer Vascular Plug III, SJM, St. Paul, MN) in closing PVL generated by transcatheter balloon expandable aortic valve prosthesis in order to quantify the effective treatment of PVL. BACKGROUND Transcatheter aortic valve implantation (TAVI) procedures represent the treatment of choice for high risk patients. Despite evolving technologies paravalvular leak (PVL) is still a major unaddressed issue. This severe complication significantly impairs long-term survival. Percutaneous treatment of this complication is usually performed with the implantation of not specifically designed and not approved vascular devices. METHODS A 26 mm Sapien XT (Edwards Lifesciences, Irvine, CA) was implanted in a rubber aortic root and a semi-elliptical shape PVL was created. The vascular occluder devices were implanted in the PVL and hemodynamic performance was tested in a pulse duplicator according to international standard ISO 5840-3:2013. Different type of comparison tests together with high speed camera recording allowed us to define the global efficiency of the occluders and their interaction with the transcatheter prosthesis. RESULTS The results revealed that the use of vascular plugs was not per se sufficient to produce an effective or substantial reduction of PVL with a maximum efficiency of less than 50%. Recorded video showed clearly that the vascular plug always interfered with the leaflet of the prosthetic valve. CONCLUSIONS Currently used devices do not guarantee effective treatment of PVL and may otherwise compromise the structural integrity of the prosthetic valve implanted. Specifically designed devices are required. CONDENSED ABSTRACT Despite evolving technologies, paravalvular leak (PVL) is still a major unaddressed issue after transcatheter aortic valve implantation. Percutaneous treatment of this complication is usually performed with the implantation of Amplatzer devices not specifically designed and not approved for this specific use. We tested Amplatzer devices in a pulse duplicator to occlude PVL generated after implantation of a 26 mm SAPIENT XT prosthesis. The results revealed that the use of vascular plugs was not per se sufficient to produce an effective or substantial reduction of PVL. The video showed clearly that the vascular plug always interfered with the leaflet of the prosthetic valve.
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Affiliation(s)
- Gaetano Burriesci
- UCL Cardiovascular Engineering Laboratory, UCL Mechanical Engineering/IBME, University College London, United Kingdom
| | - Paolo Peruzzo
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, Italy
| | - Francesca Maria Susin
- Department of Civil, Environmental, and Architectural Engineering, University of Padova, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Cardiology, Thoracic and Vascular Sciences, University of Padova Medical School, Italy
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Sampaio RO, de Oliveira AG, Miranda GB, Lemos Neto PA, Vieira MLC, Tarasoutchi F. Percutaneous Treatment of Mitral Paraprosthetic Regurgitation: an Alternative to Surgery. Arq Bras Cardiol 2015; 105:440-2. [PMID: 26559992 PMCID: PMC4633009 DOI: 10.5935/abc.20150115] [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: 05/06/2014] [Accepted: 09/30/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
- Roney Orismar Sampaio
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - George Barreto Miranda
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Alves Lemos Neto
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Flávio Tarasoutchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Imaging During Percutaneous Valvular Heart DiseaseInterventions: Is More Better or Less? CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Real-time three-dimensional echocardiography: never before clinical efficacy looked so picturesque. Int J Cardiol 2015; 198:15-21. [DOI: 10.1016/j.ijcard.2015.06.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/04/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022]
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32
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Lampropoulos K, Aggeli C, Megalou A, Barbetseas J, Budts W. Diagnosis and Treatment of Left-Sided Prosthetic Paravalvular Regurgitation. Cardiology 2015; 133:27-34. [DOI: 10.1159/000439247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022]
Abstract
Paravalvular leak (PVL) is a complication related to the surgical implantation of left-sided prosthetic valves. The prevalence of paravalvular regurgitation ranges between 5 and 20%. Left-sided prosthetic paravalvular regurgitation presents with a wide constellation of signs and symptoms ranging from asymptomatic murmur to heart failure, hemolysis and cardiac cachexia. Echocardiography plays a key role in imaging the PVL and can help in guiding the closure procedure with both transesophageal and intracardiac probes. Transcatheter closure of paravalvular regurgitations is an appealing prospect.
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33
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Ghimire G, Capps C, Alli O. Device closure of periprosthetic paravalvular regurgitation. Expert Rev Med Devices 2015; 12:559-70. [PMID: 26305839 DOI: 10.1586/17434440.2015.1075387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Periprosthetic paravalvular regurgitation is an important sequel associated with prosthetic valves whether implanted surgically or via transcatheter approach. They can remain clinically silent or manifest as clinical heart failure, intravascular hemolysis or a combination of both. Periprosthetic defects are becoming increasingly recognized as a source of morbidity and mortality in patients with prosthetic heart valves and in the last few years, the management of this condition has evolved. This review aims to address the current knowledge on the pathophysiology, imaging modalities and management of these defects. It further details the principles, methodology and outcomes of catheter-based device therapy of periprosthetic paravalvular defects.
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Affiliation(s)
- Gopal Ghimire
- a Division of Cardiology, Department of Internal Medicine University of Alabama, Birmingham, USA
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34
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Godinho AR, Almeida PB, Sousa C, Gonçalves A, Silva JC, Maciel MJ. Late device embolization in a persistent mitral paravalvular leak. Rev Port Cardiol 2015; 34:291.e1-4. [PMID: 25840646 DOI: 10.1016/j.repc.2014.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/08/2014] [Accepted: 10/10/2014] [Indexed: 11/30/2022] Open
Abstract
An 83-year-old man with severe organic mitral regurgitation underwent mitral valve surgery with implantation of a biologic prosthesis. Four months later he presented with hemolytic anemia and heart failure due to severe paravalvular regurgitation. Since the patient refused surgery, the paravalvular leak was closed percutaneously using two Amplatzer devices, with angiographic and clinical success. Two months after the intervention he developed heart failure again and embolization of one of the devices was documented, with significant worsening of paravalvular regurgitation. A redo percutaneous closure was attempted but although initially promising, was ultimately unsuccessful as heart failure symptoms and hemolytic anemia persisted. Surgical correction was the final solution for this case. This is the second case of late device embolization reported in the literature and highlights the importance of careful long-term follow-up of such patients, as late complications, although rare, may occur.
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Affiliation(s)
| | | | - Carla Sousa
- Serviço de Cardiologia, Hospital de São João, Porto, Portugal
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35
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Godinho AR, Almeida PB, Sousa C, Gonçalves A, Silva JC, Maciel MJ. Late device embolization in a persistent mitral paravalvular leak. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Quader N, Davidson CJ, Rigolin VH. Percutaneous closure of perivalvular mitral regurgitation: how should the interventionalists and the echocardiographers communicate? J Am Soc Echocardiogr 2015; 28:497-508. [PMID: 25772020 DOI: 10.1016/j.echo.2015.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Indexed: 11/17/2022]
Abstract
There is considerable interest in percutaneous closure of perivalvular leaks without the need for repeat surgery. Successful percutaneous closure of these defects requires extensive planning and coordination before and during the procedure. However, there is no standardized description of valve pathology in the presence of a prosthetic valve, which adds to the challenge of communication. Transesophageal echocardiography is ideally suited to guide percutaneous mitral valve procedures, because of the proximity of the mitral valve to the esophagus. Successful percutaneous procedures of the mitral valve require teamwork. Both the interventionalist and the echocardiographer must have great familiarity with mitral valve anatomy, structure, and function, and they must know how to effectively communicate with each other. The authors review the relevant periprocedural mapping of the mitral valve and provide guidance to echocardiographers and interventionalists on effective ways to communicate during percutaneous perivalvular mitral leak closures to accomplish a successful outcome.
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Affiliation(s)
- Nishath Quader
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Vera H Rigolin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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37
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Three-Dimensional Color Doppler Transesophageal Echocardiography for Mitral Paravalvular Leak Quantification and Evaluation of Percutaneous Closure Success. J Am Soc Echocardiogr 2014; 27:1153-63. [DOI: 10.1016/j.echo.2014.08.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Indexed: 01/24/2023]
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38
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McElhinney DB. Will there ever be a Food and Drug Administration-approved device for transcatheter paravalvular leak closure? Circ Cardiovasc Interv 2014; 7:2-5. [PMID: 24550528 DOI: 10.1161/circinterventions.114.001286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Doff B McElhinney
- From the Departments of Pediatrics, Medicine, and Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY
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39
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Abstract
Transesophageal echocardiography provides excellent visualization of the posteriorly located mitral valve. Over the last decade, 3-dimensional transesophageal echocardiography (3D TEE) has emerged as an exciting imaging modality, particularly of the mitral valve. The current generation matrix array technology allows the operator to perform 2D and 3D imaging with a single transducer. 3D TEE affords the unique ability to view the mitral valve and its surrounding structures "en face" in real time (RT), and provide contextual anatomical guidance during surgical and transcatheter interventions. Additionally, offline quantification has made significant contributions to our mechanistic understanding of the normal and diseased mitral valve, and alterations induced by therapeutic intervention such as surgical repair. This review will address recent advances in the incremental role of 3D TEE in mitral valve imaging.
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40
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Kilic T, Sahin T, Ural E. Percutaneous retrograde transfemoral closure of mitral paravalvular leak in 3 patients without construction of an arteriovenous wire loop. Tex Heart Inst J 2014; 41:170-3. [PMID: 24808777 DOI: 10.14503/thij-12-3017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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.
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Affiliation(s)
- Teoman Kilic
- 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
| | - Tayfun Sahin
- 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
| | - Ertan Ural
- 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
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41
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Reed GW, Tuzcu EM, Kapadia SR, Krishnaswamy A. Catheter-based closure of paravalvular leak. Expert Rev Cardiovasc Ther 2014; 12:681-92. [DOI: 10.1586/14779072.2014.915193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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García E, Sandoval J, Unzue L, Hernandez-Antolin R, Almería C, Macaya C. Paravalvular leaks: mechanisms, diagnosis and management. EUROINTERVENTION 2014; 8 Suppl Q:Q41-52. [PMID: 22995111 DOI: 10.4244/eijv8sqa9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To understand the incidence, aetiology and mechanisms of paravalvular aortic and mitral leaks after valvular surgery; reviewing the best methods for diagnosis, procedural guidance and result assessment of these leaks, as well as describing the different approaches to their treatment. METHODS AND RESULTS A literature search was undertaken as well as an in-depth analysis of our own experience concerning different imaging modalities and various therapeutic strategies for aortic and mitral paravalvular leaks. The majority of patients were diagnosed using two- or three-dimensional transoesophageal echocardiography, useful in both guiding the procedure as well as assessing the procedural results. Haemoglobin, haematocrit, LDH and haptoglobin values were analysed to assess haemolysis. Procedural success for percutaneous closure of paravalvular aortic leaks are around 90% in the different series, with low complication rates. Mitral leaks have been approached by transfemoral and transapical access; the reported success of this procedure ranges from 75% to more than 90% in different reports. Complication rates at 30 days average 10% and mortality related to the procedure is around 1%. Late follow-up results depend on the initial anatomy, baseline clinical class and procedure results. CONCLUSIONS Paravalvular leaks after surgical valve implantation have a multifactorial aetiology, but are mainly related to specific anatomic characteristics of the valvular ring. Mitral leaks are three times more common than aortic leaks and the incidence increases after reoperation. Different percutaneous techniques with several devices have been explored for leak closure, but we are still lacking devices specifically designed to treat this pathology more effectively.
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Affiliation(s)
- Eulogio García
- Interventional Cardiology, Cardiac Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
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43
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Transapical closure of mitral paravalvular leak over a surgically constructed mitral annulus. Int J Cardiol 2014; 171:302-4. [DOI: 10.1016/j.ijcard.2013.11.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/23/2013] [Indexed: 11/19/2022]
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44
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Tarantini G, Mojoli M, Napodano M. Mitral paravalvular leak closure by antegrade percutaneous approach: three-dimensional transesophageal echocardiographic guided multiple Amplatzer implantation by a modified sequential anchoring-based technique. Catheter Cardiovasc Interv 2013; 82:E626-9. [PMID: 23613380 DOI: 10.1002/ccd.24977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 03/04/2013] [Accepted: 04/13/2013] [Indexed: 11/06/2022]
Abstract
We describe the technical aspects and the possible advantages of a modified anchoring-based technique for the implantation of multiple Amplatzer devices, in a case of large anteroseptal mitral paravalvular leak causing massive regurgitation, which was manaed by antegrade transseptal, single-stage, percutaneous approach. Real-time three-dimensional transesophageal echocardiographic guidance was crucial to ensure successful recrossings of the target defect and the optimal anatomical closure.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, Policlinico Universitario, Padua, Italy
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45
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Abstract
Interventional techniques for percutaneous treatment of structural heart disease have become an important option for patients ineligible for conventional operating procedures in cardiovascular medicine. Echocardiography plays an essential role not only for patient selection but also for guiding transcatheter interventions in order to safely accomplish the procedure. Echocardiographic 2D and 3D techniques next to conventional fluoroscopy have therefore become an integral part for monitoring interventional procedures in the catheter laboratory. This review aims to describe new developments for the application of echocardiography during transcatheter interventions in the context of the current literature and current recommendations.
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Affiliation(s)
- J Balzer
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany.
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Krishnaswamy A, Tuzcu EM, Kapadia SR. Percutaneous Paravalvular Leak Closure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:565-74. [DOI: 10.1007/s11936-013-0262-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sharma VK, Radhakrishnan S, Mathur A, Shrivastava S. Three dimensional transesophageal echocardiography guided transcatheter closure of mitral paraprosthesis regurgitation - a case report. Indian Heart J 2013; 65:286-8. [PMID: 23809383 DOI: 10.1016/j.ihj.2013.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 04/03/2013] [Indexed: 11/17/2022] Open
Abstract
The last two decades have witnessed vast advances in the field of cardiac intervention, particularly with regard to nonsurgical closure of structural heart diseases including para prosthetic valvular leaks. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures. The present case report aims to highlight the role of three dimensional transesophageal echocardiography in pre, intra and post operative management of patients with mitral para prosthetic valvular regurgitation.
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Affiliation(s)
- Vinay Kumar Sharma
- Senior Consultant Cardiologist, Department of Non-Invasive Cardiology, Fortis Escorts Heart Institute and Research Centre Ltd., Okhla Road, New Delhi 110025, India.
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Sivakumar K. Transcatheter closure of paravalvular leaks - how do I do it? Indian Heart J 2013; 65:289-94. [PMID: 23809384 DOI: 10.1016/j.ihj.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/03/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kothandam Sivakumar
- Chief Pediatric Cardiologist and Senior Consultant, MIOT Hospital, 4/112, Mount Poonamalle Road, Manapakkam, Chennai 600089, India.
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Goktekin O, Vatankulu MA, Tasal A, Sönmez O, Başel H, Topuz U, Ergelen M, Hijazi ZM. Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a new device: first in man experience. Catheter Cardiovasc Interv 2013; 83:308-14. [PMID: 23703912 DOI: 10.1002/ccd.25006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/25/2013] [Accepted: 05/12/2013] [Indexed: 11/06/2022]
Abstract
This report describes the first use of a new paravalvular leak (PVL) device designed specifically to close paravalvular mitral and paravalvular aortic leaks. The first patient had severe paravalvular mitral leak that was closed using the transapical route with a rectangular designed PVL device that has an oval waist for self-centering and the second patient had moderate paravalvular aortic leak that was closed with a square designed device that has a round waist for self-centering. Both patients had complete closure.
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Affiliation(s)
- Omer Goktekin
- Department of Interventional Cardiology, Bezmialem University, Istanbul, Turkey
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