Novel use of the Amplatzer duct occluder to close perivalvar leak involving a prosthetic mitral valve

Kort, Henry W.; Sharkey, Angela M.; Balzer, David T.

doi:10.1002/ccd.10785

Cited by 56 publications

(23 citation statements)

References 41 publications

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“…Moreover, surgery may not be successful since the original anatomical problems persist. Because of these issues, there is tremendous interest in minimally invasive percutaneous techniques that may allow successful treatment of paravalvular regurgitation without another sternotomy (2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Principles Of Percutaneous Paravalvular Leak Closurementioning

confidence: 99%

Principles of Percutaneous Paravalvular Leak Closure

Rihal

Sorajja

Booker

et al. 2012

JACC: Cardiovascular Interventions

156

106

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Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for characterizing the defect location, size, and shape. For paramitral defects, an antegrade transseptal approach can usually be guided by biplane fluoroscopy, and real-time 3-dimensional transesophageal echocardiography can usually be performed successfully. Alternative approaches to paramitral defects include retrograde transaortic cannulation or transapical access and retrograde cannulation. For oblong or crescentic defects, the simultaneous or sequential deployment of 2 smaller devices, as opposed to 1 large device, results in a higher degree of procedural success and safety because the risk of impingement on the prosthetic leaflets is minimized. Most para-aortic defects can be approached in a retrograde manner and closed with a single device. With careful anatomical assessment, procedural planning, and procedural execution, successful closure rates of 90% or more should be attainable with a low risk of device impingement on the prosthetic valve or embolization.

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Section: Principles Of Percutaneous Paravalvular Leak Closurementioning

confidence: 99%

Principles of Percutaneous Paravalvular Leak Closure

Rihal

Sorajja

Booker

et al. 2012

JACC: Cardiovascular Interventions

156

106

View full text Add to dashboard Cite

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“…Surgical intervention is recommended in adult patients with symptomatic PVLs, though reoperation is associated with mortality rates approaching 16% (4). Percutaneous transcatheter closure procedures, which are routinely applied in the management of various intracardiac defects and vascular communications (5,6), have been applied to the treatment of PVLs using a variety of techniques (2,(7)(8)(9)(10)(11)(12). Experience with transcatheter mitral PVL closure has achieved variable success (Table 1), with reported initial technical success rates of 60% to 90% and a need for repeat intervention in up to 40% of cases (2).…”

mentioning

confidence: 99%

Percutaneous Transcatheter Closure of Prosthetic Mitral Paravalvular Leaks

Kim

Casserly

Garcia

et al. 2009

JACC: Cardiovascular Interventions

108

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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.

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“…Transcatheter closure of Mitral PVL has been reported in very few occasions using Coils, Gianturco Grifka device, Amplatzer septal or duct occluder devices [3,4] but outcome is varied, and reoperations carried out after failed transcatheter methods [5,6]. In our patient, anemia and severe mitral regurgitation causing progressive LA and LV dilatation warranted a definitive procedure.…”

mentioning

confidence: 89%