Introduction on Percutaneous Paravalvular Leak Closure
Among patients undergoing surgical valve replacement, 1–5 % of patients with an aortic valve replacement (AVR) and 2–12 % with a mitral valve replacement (MVR) may develop paravalvular regurgitation or ‘leak’ (PVL).1–3 In the era of transcatheter aortic valve replacement (TAVR) with first-generation balloon expandable valves, up to 17 % of patients may be left with moderate or severe PVL, also referred to as paravalvular aortic regurgitation (PAR).4 Risk factors for PVL in patients undergoing surgical valve replacement include the use of mechanical valves, severe calcification of the valve annulus, or valve replacement for infectious endocarditis. Similar factors contribute to PVL in the post-TAVR setting, as well as improper pre-procedural valve sizing.5
The majority of patients who have symptomatic PVL present with congestive heart failure (CHF) (85 %), and a significant number may have haemolysis (50 %).6,7 Patients who fail medical therapy directed at CHF and/or haemolysis (erythropoietic agents, blood transfusion) should be considered for redo open-heart surgery (OHS) or percutaneous PVL closure. Re-operation must be approached cautiously, as redo surgery usually carries greater risk than a first operation, and recurrence of PVL may be seen in more than one-third of patients who undergo redo OHS for PVL.6
As a result, percutaneous PVL closure has recently gained greater favour. First reported in 1992, this procedure has been slowly evolving and is now successfully performed in a number of centres with significant experience in structural cardiac intervention.8–12 In this review, we will discuss the imaging diagnosis of PVL and data supporting percutaneous closure, as well as highlight the procedural techniques to accomplish PVL closure.