Patients with cardiac valve replacement may suffer from PVL in the acute, subacute or chronic phases after cardiac surgery. These patients present most commonly with CHF, though a significant number also have debilitating haemolysis. As surgical reoperation carries great risk and chance for PVL recurrence, percutaneous strategies have been developed. These therapies are gaining favour as operators trained in structural cardiac intervention have developed a greater understanding of this procedure and made significant improvements in technique. While no specific trials of percutaneous versus surgical closure exist, many high-volume interventional centres have been taking care of larger numbers of these patients, and consideration may be given to the percutaneous approach as the first-line treatment strategy in carefully selected patients.