Mitral valve paravalvular leaks: Comprehensive review of literature

Abstract

Background: Mitral paravalvular leaks (mPVL) are a recognized complication for patients with mitral valve prostheses. Although clinically insignificant for many patients, it may pose life-threatening haemolysis and regurgitation-induced heart failure, and so clinicians should have a high index of suspicion in the presence of new symptoms.Aims: This review discusses the pathogenesis, clinical features, diagnosis, imaging and treatment of mPVLs.Methods: A comprehensive literature search was performed using PubMed, EM-BASE, Cochrane database, Google Scholar and Ovid. Search terms used included "mitral valve paravalvular leak," "transthoracic echocardiography," "2D transoesophageal echocardiography," "3D transoesophageal echocardiography," "cardiac computed tomography," (CT) "cardiac magnetic resonance imaging," "intracardiac echocardiography," "cinefluoroscopy," "fluoroscopy," and "percutaneous closure."Results: All patients with mPVLs should undergo regular full evaluation, including patient history, physical examination, laboratory work-up, imaging, and referral, if necessary. Echocardiography is fundamental to the diagnosis, and is augmented with cardiac magnetic resonance imaging, cardiac computerized tomography and fluoroscopy for further characterization and procedural planning amongst the structural heart team. Conclusion:The prevalence of mPVL is expected to increase proportionally to the growing number of surgical and transcatheter valve replacements conducted in the ageing population. Multimodal imaging is instrumental in guiding diagnostic and therapeutic strategies when managing mPVLs. Advances in imaging and capabilities of transcather devices will prompt growing uptake of percutaneous treatment over conventional, higher-risk surgery for mPVL management.

A Nearly Missed Case of Mitral Bioprosthetic Paravalvular Leak (PVL)-Related Waring Blender Syndrome Treated With Transcatheter Mitral PVL Closure

“…A paravalvular leak is a well-established cause of hemolytic anemia in patients with prosthetic heart valves, a condition commonly known to occur in the early postoperative period. Although mitral paravalvular leaks, for the most part, remain clinically insignificant, in some patients, they can cause life-threatening hemolysis and regurgitation-induced heart failure [3]. These complications arise due to increased shear stress on red blood cells, resulting from turbulent flow through the defect that causes mechanical trauma and red blood cell fragmentation [4].…”

Como Eu Faço Abordagem para Avaliação de Leak Paraprotético Mitral

“…1,3 Na topografia da valva mitral, esse achado é encontrado em até 15% dos pacientes submetidos à troca valvar mitral. 5 Diante do risco crescente em novas abordagens cirúrgicas, o tratamento transcateter tem sido cada vez mais frequente em casos de anatomias favoráveis em centros especializados. No entanto, algumas complicações podem acontecer, como interferência do dispositivo implantado com a prótese ou estrutura anatômica adjacente.…”

My Approach to Assessment of Mitral Paraprosthetic Leak

“…1,3 In mitral valve topography, this finding is seen in up to 15% of patients undergoing mitral valve replacement. 5 According to recent guidelines, [2][3][4] leak repair is recommended for patients experiencing clinical heart failure or significant hemolysis.…”