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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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Lytra T, Kalogeras K, Pesiridis T, Moldovan C, Vavuranakis MA, Vogiatzi G, Oikonomou E, Dardas P, Chrissoheris M, Ninios V, Vavuranakis M. Correlation of Clinical Outcomes with the Prominent Indication of Transcatheter Paravalvular Leak Closure: A Multicenter Experience. J Clin Med 2023; 12:4047. [PMID: 37373740 DOI: 10.3390/jcm12124047] [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: 03/22/2023] [Revised: 05/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND A paravalvular leak (PVL) is a complication following valve replacement, which may lead to heart failure and hemolysis. The aim of this study is to investigate whether the clinical outcome after transcatheter PVL closure differs according to the prominent indication of the procedure (symptoms of heart failure or hemolysis). METHODS The data of consecutive patients who had transcatheter treatment for PVL between July 2011 and September 2022 in five Greek centers were analyzed. The primary endpoint was the technical, and clinical success rates with regards to the prominent indication of paravalvular leak closure. The secondary endpoints included the evaluation and comparison of the clinical and technical success in relation to the type of valve that was treated (aortic or mitral) as well as the survival analysis in relation to the closure indication and type of valve that was treated. RESULTS In total, 60 patients were retrospectively studied (39% men, mean age 69.5 ± 11 years). Regarding the primary outcomes, the technical success in patients mainly suffering from hemolysis was 86.1%, while in those presenting heart failure it was 95.8%, p = 0.387. Furthermore, the clinical success was 72.2% and 87.5% among hemolysis and heart failure patients, respectively, p = 0.210. During the follow-up period, the two-year survival rates were significantly better for patients treated for the aortic valve (78.94%) compared to those in the mitral position (48.78%), p = 0.014. In total, 25 patients died (41.7%) during 24 months of follow-up. CONCLUSIONS Transcatheter paravalvular leak closure can be performed with high technical and clinical success rates without any difference according to the prominent indication of closure.
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Affiliation(s)
- Thekla Lytra
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Carmen Moldovan
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | | | - Georgia Vogiatzi
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Evaggelos Oikonomou
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Petros Dardas
- Cardiology Department, Aghios Loukas Hospital, 55236 Thessaloniki, Greece
| | | | - Vlasis Ninios
- Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece
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Onorato EM, Vercellino M, Costante A, Bartorelli AL. Case Report: Challenging Treatment of an AorticParavalvular Leak: How We Avoided Interference With Mechanical Valve Function? Front Cardiovasc Med 2022; 9:839159. [PMID: 35833184 PMCID: PMC9272523 DOI: 10.3389/fcvm.2022.839159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Aortic paravalvular leak (APVL) after surgical valve replacement (AVR) is an ominous complication with a high risk of morbidity and mortality. Approximately 1–5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or hemolytic anemia. Case Summary A 69-year-old man with multiple comorbidities underwent surgical replacement of the aortic valve with a mechanical tilting disc prosthetic valve (Medtronic Starlight 27 mm). Several years later, recurrent episodes of congestive heart failure and hemolytic anemia developed due to a large crescent-shaped aortic PVL located at non coronary cusp (NCC) 9–12 o'clock, with moderate-to-severe regurgitation. The patient was deemed at prohibitive surgical risk due to significant multiple comorbidities and a transcatheter PVL closure (TPVLc) was planned. The huge PVL was partially closed by a first specifically designed paravalvular leak device (PLD). The procedure was complicated by transient interference of the second PLD with mechanical prosthetic valve function. This issue has however been solved with correct manipulation, orientation and downsizing of the second device implanted. At 3-month and 13-month follow-up, the patient showed a relevant clinical improvement and good quality of life. 2D TTE color Doppler confirmed the stable position of the two PLDs with trace residual leak. Discussion Surgical redo has been considered the treatment of choice for symptomatic patients with PVLs. Notwithstanding, TPVLc is a less invasive alternative, particularly in patients at high surgical risk in whom early diagnosis and prompt interventional treatment are crucial for improving expectancy and quality of life. Dedicated devices, appropriate procedural techniques, and the close interaction between imaging modalities, allowed to deal successfully with a challenging case of severe symptomatic aortic PVL.
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Affiliation(s)
- Eustaquio Maria Onorato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- *Correspondence: Eustaquio Maria Onorato ; orcid.org/0000-0002-6750-5682
| | - Matteo Vercellino
- Cardiology Department, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Annamaria Costante
- Cardiology Department, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
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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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Zheng J, Tao T, Davies H, Wu S, Ni Y. Four novel suture-sealing techniques to repair varying size paravalvular leaks. J Card Surg 2021; 36:3848-3850. [PMID: 34288102 DOI: 10.1111/jocs.15819] [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: 06/06/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) is a well-known complication of aortic valve replacement. Currently, there is no consensus on optimal intraoperative management of patients with mild-to-moderate or moderate PVL. TECHNIQUE In this paper we present four novel surgical techniques, each combining suturing with sealing technique, to repair aortic PVLs, nullifying the need to replace the prosthesis. CONCLUSION These techniques will offer cardiac surgeons new alternatives to the repair techniques currently used.
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Affiliation(s)
- Junnan Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tingting Tao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Henry Davies
- Department of Vascular Surgery, School of Medicine, University of Leeds, Leeds, UK
| | - Shengjun Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
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Kalogeras K, Ntalekou K, Aggeli K, Moldovan C, Katsianos E, Kalantzis C, Bei E, Mourmouris C, Spargias K, Chrissoheris M, Dardas P, Aznaouridis K, Tzifa A, Theofilogiannakos E, Siasos G, Tousoulis D, Vavuranakis M. Transcatheter closure of paravalvular leak: Multicenter experience and follow-up. Hellenic J Cardiol 2021; 62:416-422. [PMID: 33617960 DOI: 10.1016/j.hjc.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Paravalvular leak (PVL) is a common complication following valve replacement, which leads to heart failure and hemolysis. Transcatheter PVL closure has emerged as a reliable alternative with promising results. We quote the combined three-center experience of PVL patients treated percutaneously. METHODS Consecutive patients treated percutaneously for PVL were retrospectively studied. Procedural characteristics, inhospital, and long-term clinical outcomes were assessed. Technical (successful deployment) and clinical (NYHA and/or hemolysis improvement) success were evaluated. RESULTS In total, 39 patients treated for PVL in either the aortic (12 patients) or the mitral (27 patients) position were studied. Amplatzer Vascular Plug III was the most commonly used device among the 45 devices totally implanted. Postprocedurally, the rates of at least moderate PVL (87.5% preprocedurally vs 10.5% at discharge) and functional status (mean NYHA class 2.8 ± 0.7 on admission vs 1.5 ± 0.8 at follow-up) were statistically significantly improved. Total population technical success rate was 89.7%, being comparable between patients treated for mitral or aortic valve PVLs (92.6% vs 83.3%, respectively). Clinical success was achieved in 82.1% of patient cohort without statistical difference among those with isolated aortic or mitral PVL or among those with PVL closure an indication of heart failure or hemolysis. During a mean follow-up of 33.5 months, five patients died, including one periprocedural death. CONCLUSIONS This multicenter recorded experience confirms that percutaneous PVL closure can be performed with high technical and clinical success rates and limited complications that lead to significant PVL reduction and functional status improvement.
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Affiliation(s)
- Konstantinos Kalogeras
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece.
| | - Konstantina Ntalekou
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Konstantina Aggeli
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Carmen Moldovan
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Efstratios Katsianos
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece
| | - Charalambos Kalantzis
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Evelina Bei
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | | | | | | | - Petros Dardas
- Cardiology Department, 'Aghios Loukas' Hospital, Thessaloniki, Greece
| | | | - Afroditi Tzifa
- Cardiology Department, 'Hygeia' Hospital, Athens, Greece
| | | | - Gerasimos Siasos
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece
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Jabbar AA, Hasan M, Jenkins JS, Collins T, Ramee S. Elective Percutaneous Paravalvular Leak Closure Under Conscious Sedation: Procedural Techniques and Clinical Outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1291-1298. [PMID: 33246555 DOI: 10.1016/j.carrev.2020.03.003] [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: 01/29/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valves that are detected up to 18% of all implanted surgical valves. Perioperative morbidity is thought to be lower in percutaneous compared to surgical PVL repair. However, a direct comparison of PVL closure techniques has never been performed. Our study is the first to demonstrate that elective PVL closure with monitored anesthesia care can be achieved with high success and low complications rates resulting in short hospital stays. METHODS This is a retrospective cohort of patients admitted electively for catheter-based treatment of symptomatic prosthetic paravalvular regurgitation from Jan 2013 to April 2018. Both mitral and aortic PVLs were included. Patients' demographics, risk factors, procedural outcomes, In-hospital and thirty-day mortality were all reported. We followed the Valve Academic Research Consortium (VARC) criteria to define device and procedural technical success. In-hospital and 30- day outcomes were assessed by retrospective chart review. RESULTS A total of 54 PVLs in thirty-seven patients were repaired (65% aortic & 35% mitral). The mean-age in the mitral cohort was lower than the aortic cohort (61 vs 72years, P<0.0001) but the two groups shared similar clinical risk factors (P>0.05). Average hospital stay was 1-2days (<1.5days overall cohort) which was significantly lower in the aortic compared to the mitral cohort (P=0.009). All procedures were guided by TEE under conscious sedation with monitored anesthesia care. Procedural technical success defined as any significant residual shunt was 81% in the overall cohort and 88% in the aortic group. No procedural deaths were reported. Short-term mortality during the first 30days was 5.4% (two patients). CONCLUSION Elective catheter-based repair of symptomatic prosthetic paravalvular regurgitation appears to be safe and effective. The use of conscious sedation with monitored anesthesia care resulted in short hospital stay.
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Affiliation(s)
- Ali Abdul Jabbar
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Mohanad Hasan
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - J Stephen Jenkins
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Tyrone Collins
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen Ramee
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America.
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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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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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Abuelatta R, Naeim HA. Percutaneous Paravalvular Leak Closure Early Post-MV Replacement With Retrieval of Embolized Muscular VSD Device. JACC Case Rep 2019; 1:471-476. [PMID: 34316859 PMCID: PMC8288593 DOI: 10.1016/j.jaccas.2019.08.024] [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: 06/14/2019] [Revised: 08/01/2019] [Accepted: 08/10/2019] [Indexed: 11/18/2022]
Abstract
This report describes a case of paravalvular leak (PVL) closure 20 days after surgery that was complicated by an embolized 10-mm device in a patient who underwent redo PVL closure after 6 months. Waiting for 3 months postoperatively to close a PVL is recommended. If earlier leak closure is mandatory, accepting a suboptimal result with a moderate residual leak is advised. (Level of Difficulty: Intermediate.)
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