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Percutaneous Transcatheter Closure of Prosthetic Mitral Paravalvular Leaks

Are We There Yet?

Michael S. Kim, MD^_*, Ivan P. Casserly, MB, BCh, FACC^_*,, Joel A. Garcia, MD, FACC^_*,, Andrew J. Klein, MD^_*, Ernesto E. Salcedo, MD, FACC^_*, John D. Carroll, MD, FACC^_*,_*

^_* University of Colorado Denver, Aurora, Colorado
Denver Veterans Affairs Medical Center, Denver, Colorado
Denver Health Medical Center, Denver, Colorado

^_* Reprint requests and correspondence: Dr. John D. Carroll, University of Colorado Denver–Anschutz Medical Campus, Leprino Office Building, Room 524, 12401 East 17th Avenue, P.O. Box 6511, Campus Box B-132, Aurora, Colorado 80045 (Email: John.Carroll{at}ucdenver.edu).

A potential complication of mitral valve replacement surgery is the development of a paravalvular leak (PVL). Percutaneous transcatheter closures of PVLs using a wide array of devices have been reported in the literature, although the procedural success rate of this approach remains variable. One major challenge of transcatheter mitral PVL closure lies in the ability to adequately visualize the area of interest to facilitate defect crossing and equipment selection. Furthermore, the current spectrum of devices available for off-label use in the closure of these unique defects remains limited. This review examines the current state of transcatheter prosthetic mitral PVL closure, describes our institution's experience using advanced imaging modalities for procedural guidance, and illustrates some of the limitations associated with using existing devices in transcatheter PVL closure.

Key Words: paravalvular leak • perivalvular leak • mitral valve • prosthetic valve • 3-dimensional echocardiography • percutaneous transcatheter closure • rapid prototyping

Abbreviations and Acronyms   3D = three-dimensional   ASO = Amplatzer Septal Occluder device   A-V = arteriovenous   PVL = paravalvular leak   TEE = transesophageal echocardiography   VSD = ventricular septal defect

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