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  • Review Article
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Surgery Insight: percutaneous treatment of prosthetic paravalvular leaks

Abstract

Serious paravalvular leakage occurs in 1–5% of patients who have undergone surgical cardiac valve replacement procedures. Clinical manifestations include hemolysis, heart failure and arrhythmias. Presently, the gold standard treatment for severe paravalvular leakage is surgery; however, the outcomes remain far from optimum. In this Review we discuss the problem of paravalvular leak and focus on the role of percutaneous repair as a treatment option.

Key Points

  • Serious paravalvular leak following valve replacement occurs in 1–5% of patients

  • Severe paravalvular leaks can clinically manifest as heart failure, hemolysis and arrhythmias

  • Repeat surgery is associated with considerable morbidity in some patients; percutaneous treatment should be considered in these patients on an individual basis, taking into consideration patient preference and operator and center experience

  • Percutaneous repair of paravalvular leaks can be safely and effectively achieved using modification of currently available equipment and devices

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Figure 1: Potential antegrade approaches to percutaneous repair of a mitral paravalvular leak.
Figure 2: Fluoroscopic images demonstrating key stages in the percutaneous repair of an aortic paravalvular leak via a retrograde approach.
Figure 3: Aortography before and after the percutaneous treatment of an aortic paravalvular leak.
Figure 4: Intracardiac echocardiographic images demonstrating closure of a paravalvular mitral leak performed with the probe in the left atrium through an atria septal defect.
Figure 5: Fluoroscopic images demonstrating the use of multiple devices (arrows), which were required to treat an aortic paravalvular leak.

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Correspondence to Ravinay Bhindi.

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The authors declare no competing financial interests.

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Bhindi, R., Bull, S., Schrale, R. et al. Surgery Insight: percutaneous treatment of prosthetic paravalvular leaks. Nat Rev Cardiol 5, 140–147 (2008). https://doi.org/10.1038/ncpcardio1112

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