Mitral Paravalvular Leak: Clinical Implications, Diagnosis and Management

Abstract

Paravalvular leak incidence after mitral surgical replacement ranges from 7% to 17%. Between 1% and 5% of these are clinically significant. Large PVLs can cause important clinical manifestations such as heart failure or haemolysis. Current guidelines consider that surgical reparation is the gold-standard therapy in symptomatic patients with paravalvular leak. However, these recommendations are based in non-randomized observational registries. On the other hand, transcatheter paravalvular leak closure has shown excellent results with a low rate of complications, and nowadays it is considered the first option in selected patients in some experienced centres. In this review, we summarize the clinical manifestations, diagnosis, procedural details, and results of transcatheter mitral PVL closure.

Transapical concomitant transseptal transcatheter closure of a giant mitral paravalvular leak under three‐dimensional printing guidance

“…Depending on the location and size of the defect and the characteristics of the patients, mitral PVL occlusion can be achieved using catheter‐based techniques via the various approaches as the preferred therapeutic option in experienced centers 1‐3 . The retrograde transfemoral approach is commonly used for mitral PVL occlusion.…”

“…preferred therapeutic option in experienced centers. [1][2][3] The retrograde transfemoral approach is commonly used for mitral PVL occlusion. However, it is generally contraindicated in the presence of a mechanical aortic valve prosthesis.…”

“…A paravalvular leak (PVL) affects approximately 7%-17% of patients who have previously undergone surgical mitral valve replacement. 1 This condition is associated with an increased risk of mortality. In recent years, catheter-based interventions have emerged as a promising alternative to redo surgery for treating heart failure and/or hemolytic anemia caused by mitral PVL.…”

“…A paravalvular leak (PVL) affects approximately 7%–17% of patients who have previously undergone surgical mitral valve replacement 1 . This condition is associated with an increased risk of mortality.…”

Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation

“…Paravalvular leak (PVL) is a life‐threatening complication of prosthetic valve replacement, which affects approximately 7%−17% of patients with mitral valve prostheses. 1 This relatively uncommon yet grave complication primarily ensues from factors such as annular calcification, suboptimal suture lines attributable to technical errors, suture failure, annular disruption, and endocarditis. 2 Patients with severe PVL are at risk of developing serious clinical consequences, including progressive heart failure and hemolytic anemia.…”