Objective To elucidate the techniques of transcatheter closure of paravalvular leak (PVL) by Amplatzer occluder, and evaluate its feasibility, effectiveness, and safety.
Methods 5 patients with PVL (4 males and 1 female), with a mean age of 58.6±17.2 (ranged from 38 to 81). Aortic mechanical valve (2), mitral bioprosthetic valve (2), and double mechanical valves (1) replacements were involved. We attempted percutaneous transcatheter closure of PVLs in 4 patients of single valve replacements. Patients requiring double mechanical valves replacement were treated by a team formed by interventionalist and cardiac surgeons. The team used a mini thoracotomy with direct transapical puncture of the left ventricle via a ‘hybrid’ approach, in order to close mitral PVL under general anaesthesia.
Results We used Chinese-made Amplatzer occluder to close PVLs. All procedures were technically successful. 5 patients of our group reported significant symptomatic improvements during short term follow-up after procedure. 2 patients of aortic PVLs had achieved complete occlusion without residual regurgitation, 3 patients of mitral PVLs closure demonstrated that there had been tiny or mild mitral paraprosthetic leak. However, no interference with valve leaflet motion were diagnosed by transthoracic echocardiography after the procedure. In our group, cardiac perforation and pericardium tamponade occurred in 1 patient with aortic PVL during interventional therapy, who recovered after being given emergent pericardiocentesis. Other 3 patients treated by mitral PVLs closure had transient severe haemolysis, which were resolved after 1 to 3 weeks.
Conclusions Percutaneous or transapical left ventricular access closure of PVLs is technically demanding, but is feasible and safe in selected patients, with a reasonable degree of technical and clinical success. However, there are still a variety of complications, technical and device improvement. Methodology standardisation is further required.
- Percutaneous intervention
- paravalvular leak
- direct puncture
- occlusion device
- valve replacement, paravalvular leak (PVL)