Advertisement

Pediatric Cardiology

, Volume 32, Issue 1, pp 113–116 | Cite as

Percutaneous Transcatheter Closure of a Paravalvular Leak in a 20-Month Old Child

  • Elizabeth Stein
  • Craig SableEmail author
  • Mary Donofrio
  • Michael Slack
Images in Pediatric Cardiology

A 20-month-old boy was referred to the cardiac catheterization laboratory for closure of a large prosthetic mitral valve paravalvular leak. At birth, the boy had an unbalanced atrioventricular septal defect with borderline hypoplasia of the mitral component of the common atrioventricular valve and the left ventricle.

At the age of 3 months, the boy underwent complete (two-ventricle) repair. The intraoperative findings included deficient left-sided atrioventricular valve tissue. As a result of the surgical septation, the coronary sinus ostium was located in the left atrium.

The boy initially did well, but 6 weeks after his initial surgery, progressive and severe mitral regurgitation developed, necessitating mitral valve replacement with a 19-mm St. Jude prosthetic valve in the supraannular position. A small (posteromedial) paravalvular prosthetic mitral leak was noted approximately 6 months after surgery. This leak became progressively worse, resulting in moderate to severe functional...

Keywords

Coronary Sinus Prosthetic Valve Paravalvular Leak Atrioventricular Septal Defect Coronary Sinus Ostium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

246_2010_9830_MOESM1_ESM.avi (1.6 mb)
Movie 1 (a) Transthoracic three-dimensional echocardiographic image in the apical projection showing the medioposterior paravalvular leak (arrow) and its relation to the enlarged coronary sinus. (b) Periprocedural transesophageal two-dimensional echocardiography illustrating the paravalvular leak (arrow). Color Doppler (right) illustrates how the flow hugs the atrial septum and leaks into the left atrium (Supplementary material 1 AVI 1646 kb)

Supplementary material 2 (AVI 8712 kb)

246_2010_9830_MOESM3_ESM.avi (3.6 mb)
Movie 2 Left ventriculogram (Movie 2a and b) showing initial leak into the left atrium (left upper frame, arrow) and later filling of the aneurysmal coronary sinus (right upper frame). Direct injection into the coronary sinus in the left anterior oblique (Movie 2c) and lateral projections (Movie 2d) showing dilation and venous collateral flow. Supplementary material 3 (AVI 3702 kb)
246_2010_9830_MOESM4_ESM.avi (1.2 mb)
Supplementary material 4 (AVI 1213 kb)
246_2010_9830_MOESM5_ESM.avi (1 mb)
Supplementary material 5 (AVI 1072 kb)

Movie 3 Transesophageal echocardiography after device placement (Movie 3a) and fluoroscopy during device release (Movie 3b) showing near complete elimination of the paravalvular leak by the occlusion device. The left ventricular disc is open completely and likely protrudes into the coronary sinus. The left atrial disc is partially open but still in good position. Supplementary material 6 (AVI 5220 kb)

246_2010_9830_MOESM7_ESM.avi (2.3 mb)
Supplementary material 7 (AVI 2317 kb)
246_2010_9830_MOESM8_ESM.avi (2 mb)
Supplementary material 8 (AVI 2094 kb)

Movie 4 Transthoracic echocardiography on postprocedural day 5 (left) showing a thrombus in the coronary sinus and on postprocedure day 15 (right) showing resolution of the thrombus. Supplementary material 9 (AVI 16802 kb)

References

  1. 1.
    Kim MS, Casserly IP, Garcia JA, Klein AJ, Salcedo EE, Carroll JD (2009) Percutaneous transcatheter closure of prosthetic mitral paravalvular leaks: are we there yet? J Am Coll Cardiol Intv 2:81–90Google Scholar
  2. 2.
    Pate GE, Al Zubaidi A, Chandavimol M, Thompson CR, Munt BI, Webb JG (2006) Percutaneous closure of prosthetic paravalvular leaks: case series and review. Cath Cardiol Int 68:528–533CrossRefGoogle Scholar
  3. 3.
    Hein R, Wunderlich N, Wilson N, Slevert H (2008) New concepts in transcatheter closing of perivalvar leaks. Future Cardiol 4:373–378PubMedCrossRefGoogle Scholar
  4. 4.
    Perk G, Lange R, Garcia-Fernandez M, Lodato J, Sugeng L, Lopez J, Knight B, Messika-Zeitoun D, Shah S, Slater J (2009) Use of real-time three-dimensional transesophageal echocardiography in intracardiac catheter-based interventions. J Am Soc Echocardiogr 22:682–865Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Elizabeth Stein
    • 1
  • Craig Sable
    • 1
    Email author
  • Mary Donofrio
    • 1
  • Michael Slack
    • 1
  1. 1.CardiologyChildren’s National Medical CenterWashingtonUSA

Personalised recommendations