IVUS guidance in percutaneous closure of aortic paraprosthetic leak
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Severe aortic regurgitation due to paraprosthetic leak appears in 1–5% of patients with previous aortic valve replacement. Surgical management is the treatment of choice but has high morbidity and mortality and leak recurrence is not uncommon. Different approaches to percutaneous closure have been tried. Transesophageal echocardiography (TEE) is a key factor to measure and localize leakages. Performing TEE during the procedure implies general anesthesia and prolongs procedure and fluoroscopy times. We report the case of an aortic paraprosthetic leak percutaneous closure using intravascular ultrasound to guide the procedure.
KeywordsIntravascular ultrasound Aortic regurgitation Paraprosthetic leak Percutaneous closure
Conflict of interest
The authors report no financial relationships or conflicts of interest regarding the content herein.
Video 1. Short axis transesophageal echocardiogram showing the paraprosthetic aortic leak (WMV 531 kb)
Video 2A. RAO view of baseline aortography showing the posterior paraprosthetic aortic leak causing severe regurgitation. RAO: right anterior oblique (WMV 1646 kb)
Video 2B. LAO view of baseline aortography showing the posterior paraprosthetic aortic leak causing severe regurgitation. LAO: left anterior oblique (WMV 1302 kb)
Video 3. Amplatzer Vascular Plug III deployment through the defect without affecting the discs function (WMV 2708 kb)
Video 4. Aortography showing the Amplatzer Vascular Plug III device positioned across the aortic paravalvular leak, without affecting the coronary ostia and with minimal residual aortic regurgitation (WMV 1271 kb)
Video 5. Control 4-chamber view of transthoracic echocardiogram showing mild residual aortic regurgitation (WMV 817 kb)
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