New Concepts in Transcatheter Closure of Paravalvular Leaks

Abstract

New catheter techniques and a large variety of endovascular devices permit transcatheter treatment - not only of common atrial or ventricular septal defects - but also of rare intracardiac malformations such as postmyocardial infarction ventricular septal defects, sinus valsalva aneurysm or paravalvular leak. Owing to the variable anatomical nature of paravalvular leaks, closure may be one of the most challenging interventional procedures in the field of structural heart disease. Current literature documents ambiguous results and endorses the limitations of this procedure. In most cases these limitations are technical. Further efforts in the development of defect-specific devices and techniques may result in an improved patient outcome and extended patient selection.

Clinical Outcomes in Patients Undergoing Percutaneous Closure of Periprosthetic Paravalvular Leaks

“…In this study, patients demonstrated significant and marked improvement in Procedure-related death 1 (2) both CHF symptoms and the need for blood transfusions for ongoing hemolysis. Hein et al (18) observed that 33% of patients requiring transfusions had worsening hemolysis after the procedure, and there was newly developed hemolysis in 10% of all patients. This series had similar results immediately after the procedure.…”

Percutaneous Closure of an Aortic Prosthetic Paravalvar Leak: An Australian First

“…Technical difficulties include crossing the leak, stable device delivery and interference with surrounding structures (particularly valve leaflet impingement and coronary ostia obstruction) [1,15]. Despite these limitations, percutaneous closure in non-surgical candidates has demonstrated symptomatic improvement (NYHA class, echocardiography and haemolysis parameters) in 70-80% of reported cases [2,16].…”

“…Most commonly, paravalvar leaks result from rupture of one or more sutures securing the prosthesis to the valve annulus, and typically occur during the first post-operative year [2]. Clinical manifestations are a consequence of reduced net cardiac output and/or transfusion-dependent haemolytic anaemia.…”

Transcatheter prosthetic paravalvular leak closure

“…More recently, the technique has been described with the off-label use of various existing Amplatzer devices ( fig. 1) for septal occlusion (ASD or muscular VSD) or patent ductus arteriosus closure [10][11][12][13][14][15][16][17]. The oval rather than circular shaped AVP (Amplatzer Vascular Plug) III device (approved in Europe and Canada but not yet in United States for vascular occlusion) has been available since 2008 and has the advantage of being better adapted to close oval or crescent-shaped leaks (the most commonly found shape of PVL).…”