Authors

• Antonia Melada — University Hospital of Split, Split, Croatia — ORCID: 0000-0003-4223-2582
• Andrija Matetić — University Hospital of Split, Split, Croatia — ORCID: 0000-0001-9272-6906
• Ivona Mustapić — University Hospital of Split, Split, Croatia — ORCID: 0000-0002-1534-3642
• Tea Domjanović Škopinić — University Hospital of Split, Split, Croatia — ORCID: 0000-0002-4989-6974
• Tina Bečić — University Hospital of Split, Split, Croatia — ORCID: 0000-0001-7596-2712
• Frane Runjić — University Hospital of Split, Split, Croatia — ORCID: 0000-0001-6639-5971
• Darija Baković Kramarić — University Hospital of Split, Split, Croatia — ORCID: 0000-0001-6751-5242

Keywords

heart valve prosthesis, mitral valve insufficiency, heart failure

DOI

Full Text

**Introduction:** Paravalvular leaks (PVLs) after surgical valve replacement have a multifactorial etiology. Mitral PVLs are more frequent than aortic PVLs and are more common in patients with mechanical as opposed to those with biological prosthesis. Patients with clinically relevant PVLs most frequently present with symptoms of heart failure, with some degree of hemolysis. (1, 2) **Case report:** 55-years-old male who underwent mitral valve replacement with a mechanical heart valve (St. Jude Medical Masters, M-33) two years earlier due to mitral valve insufficiency was now hospitalized because of suspected heart failure. He was also recently surgically treated for lung cancer with ongoing adjuvant chemotherapy. Laboratory tests were indicative of significant anemia with hemoglobin level of 81 g/L, with elements of hemolysis. Transthoracic echocardiography (TTE) revealed moderate to severe mitral PVL. Further multimodality imaging evaluation was performed (transesophageal echocardiography, cardiac computed tomography, magnetic resonance) and confirmed significant PVL originating from anteromedial region (**Figure 1****)**. The case was discussed with cardiac surgeons and because of high perioperative risk of complications, we decided to perform percutaneous transcatheter TOE guided PVL closure. The procedure was successfully preformed using a 10x5 mm Amplatzer Vascular Plug III (AVP3) (**Figure 2**). Post-procedure echocardiographic controls confirmed the effective PVL closure with only trace of residual regurgitant jet. FIGURE 1. Preprocedural transesophageal echocardiography showing a paravalvular leak originating in the anteromedial region. FIGURE 2. A) Postprocedural transesophageal echocardiography (TEE) showing good results with only a trace of residual paravalvular leak. B) 3D reconstruction of TEE appearance of the Amplatzer Vascular Plug III (indicated with the red dot). **Conclusion:** Even though surgical reoperation is still considered as the first therapeutical option for patients with symptomatic PVLs, percutaneous transcatheter PVL closure is emerging as an alternative treatment for this high-risk group.

Literature

1. García E, Sandoval J, Unzue L, Hernandez-Antolin R, Almería C, Macaya C Paravalvular leaks: mechanisms, diagnosis and management. EuroIntervention. 2012 Sep;8(Q):Q41–52. https://doi.org/10.4244/EIJV8SQA9
2. Cruz-González I, Luengo-Mondéjar P, Trejo-Velasco B, Núñez-García JC, González-Ferreiro R, Moreno-Samos JC, et al. Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience. J Clin Med. 2022 August 18;11(16):4835. https://doi.org/10.3390/jcm11164835