Two-stage percutaneous closure of paravalvular leak in a patient with stentless aortic bioprosthesis

Catheter Cardiovasc Interv. 2013 Aug 1;82(2):E119-23. doi: 10.1002/ccd.24482. Epub 2012 Jul 23.

Abstract

We report a case of successful 2-stage percutaneous closure of severe paravalvular leak (PVL) in a patient with stentless aortic bioprosthesis. Threat of pliable prosthesis compression and long course of PVL posed main considerations. Accordingly, Amplatzer vascular plug (AVP) 2 was chosen as occluder. It was delivered transfemorally under fluoroscopy and transesophageal echocardiography guidance. No prosthesis distortion was provoked at the expense of moderate residual leak. Its symptoms after 3 months spurred another AVP 2 implantation, which lead to PVL closure with no effect on valve area. Marked reduction of left ventricle cavity size and NT-proBNP plasma concentration was promptly noted and remains stable in 12-month follow-up.

Keywords: paravalvular leak; percutaneous closure; stentless bioprosthesis.

Publication types

  • Case Reports

MeSH terms

  • Aortic Valve Insufficiency / diagnosis
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Insufficiency / therapy*
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / surgery*
  • Aortography
  • Biomarkers / blood
  • Bioprosthesis*
  • Cardiac Catheterization* / instrumentation
  • Echocardiography, Doppler, Color
  • Echocardiography, Transesophageal
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation*
  • Heart Valve Prosthesis Implantation / methods
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Prosthesis Design
  • Prosthesis Failure*
  • Radiography, Interventional
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain