Skip to main content
Log in

Percutaneous Treatment of Aortic and Mitral Valve Paravalvular Regurgitation

  • Interventional Cardiology (S Rao, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Percutaneous paravalvular leak closure represents a small but important niche in structural interventions in the current era of interventional cardiology. It is estimated that paravalvular regurgitation affects 5–17 % of all surgically implanted prosthetic heart valves (which equates to 500 to 10,200 cases annually). Patients may present with clinical signs and evidence of heart failure, hemolysis or both. Due to the increased morbidity and mortality, reoperation is often best avoided, especially if the underlying perivalvular tissue is friable or heavily calcified. Perimitral defects are usually approached in an antegrade approach via a transeptal puncture; periaortic defects usually in a retrograde approach. Depending on the number, size and shape of the defect(s) - as determined by 2D and 3D echocardiography - one or multiple closure devices are deployed using various wiring and anchor techniques. This brief review provides a summary of the currently applied paravalvular leak closure techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36:1152–8.

    Article  PubMed  CAS  Google Scholar 

  2. Davila-Roman VG, Waggoner AD, Kennard ED, et al. Prevalence and severity of paravalvular regurgitation in the Artificial Valve Endocarditis Reduction Trial (AVERT) echocardiography study. J Am Coll Cardiol. 2004;44:1467–72.

    Article  PubMed  Google Scholar 

  3. Kort HW, Sharkey AM, Balzer DT. Novel use of the Amplatzer duct occluder to close perivalvar leak involving a prosthetic mitral valve. Catheter Cardiovasc Interv. 2004;61:548–51.

    Article  PubMed  Google Scholar 

  4. Moore JD, Lashus AG, Prieto LR, Drummond-Webb J, Latson LA. Transcatheter coil occlusion of perivalvular mitral leaks associated with severe hemolysis. Catheter Cardiovasc Interv. 2000;49:64–7.

    Article  PubMed  CAS  Google Scholar 

  5. Moscucci M, Deeb GM, Bach D, Eagle KA, Williams DM. Coil embolization of a periprosthetic mitral valve leak associated with severe hemolytic anemia. Circulation. 2001;104:E85–6.

    Article  PubMed  CAS  Google Scholar 

  6. Hourihan M, Perry SB, Mandell VS, et al. Transcatheter umbrella closure of valvular and paravalvular leaks. J Am Coll Cardiol. 1992;20:1371–7.

    Article  PubMed  CAS  Google Scholar 

  7. • Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30-day outcomes in 115 patients. Circ Cardiovasc Interv. 2011;4:314–21. This was the first paper reporting short term outcomes after paravalvular leak closure in the largest reported patient population.

    Article  PubMed  Google Scholar 

  8. •• Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011;58:2218–24. This is, thus far, the only paper in the literature reporting long-term outcomes of paravalvular leak closure in a relatively large patient population.

    Article  PubMed  Google Scholar 

  9. • Ruiz CE, Jelnin V, Kronzon I, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol. 2011;58:2210–7. This paper reports outcomes of the second largest paraleak population in the current literature.

    Article  PubMed  Google Scholar 

  10. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:e1–e142.

    Article  PubMed  Google Scholar 

  11. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42:S1–S44.

    Article  PubMed  Google Scholar 

  12. Jelnin V, Dudiy Y, Einhorn BN, Kronzon I, Cohen HA, Ruiz CE. Clinical experience with percutaneous left ventricular transapical access for interventions in structural heart defects a safe access and secure exit. JACC Cardiovasc Interv. 2011;4:868–74.

    Article  PubMed  Google Scholar 

  13. Morgan GJ, Waragai T, Eastaugh L, Chaturvedi RC, Lee KJ, Benson L. The fellows stitch: large caliber venous hemostasis in pediatric practice. Catheter Cardiovasc Interv. 2012;80:79–82.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Mario Gössl declares that he has no conflict of interest.

Charanjit S. Rihal declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Charanjit S. Rihal.

Additional information

This article is part of the Topical Collection on Interventional Cardiology

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gössl, M., Rihal, C.S. Percutaneous Treatment of Aortic and Mitral Valve Paravalvular Regurgitation. Curr Cardiol Rep 15, 388 (2013). https://doi.org/10.1007/s11886-013-0388-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-013-0388-9

Keywords

Navigation