Key result
Transcatheter PVL closure with an Occlutech device successfully reduces moderate-to-severe regurgitation in a high-risk patient.
Why the study?
Managing aortic paravalvular leak regurgitation following multiple surgical aortic valve replacements due to recurrent infective endocarditis presents significant clinical challenges.
Does transcatheter paravalvular leak closure reduce paravalvular leak regurgitation in a patient with multiple prior surgical aortic valve replacements and high surgical risk?
Case Report (n=1)
No
Does transcatheter paravalvular leak closure reduce paravalvular leak regurgitation in a patient with multiple prior surgical aortic valve replacements and high surgical risk?
Answers are grounded in this paper and cite their sources.
Transcatheter paravalvular leak closure is a feasible and less invasive alternative for patients with multiple prior surgical aortic valve replacements and high surgical risk.
Background Managing aortic paravalvular leak (PVL) regurgitation following multiple surgical aortic valve replacements (SAVRs) due to recurrent infective endocarditis (IE) presents significant clinical challenges. Case summary A 46-year-old woman with a history of severe aortic regurgitation and an asymptomatic membranous ventricular septal defect underwent SAVR with a bioprosthetic aortic valve (Perimount 23 mm) in 2005. Concomitantly, a double-chambered right ventricle was diagnosed. Ten years later, due to recurrent IE, another bioprosthetic valve replaced the previous valve (Magna Ease #25). In 2018, she developed sepsis from Bordetella hinzii endocarditis, leading to a third SAVR in 2019, this time with a mechanical aortic valve (On-X® #23). In 2024, two-dimensional transesophageal echocardiography (TEE) revealed moderate-to-severe PVL regurgitation near the right coronary cusp. After a multidisciplinary evaluation, transcatheter PVL closure was planned. Under general anesthesia and TEE/angio-fluoroscopic guidance, the PVL was successfully crossed via the right femoral artery, and a 10 mm × 4 mm Occlutech paravalvular leak device was deployed. Post-procedural imaging confirmed effective PVL closure with a trace-mild residual leak. Discussion This case highlights the feasibility of transcatheter PVL closure as a less invasive alternative for patients with multiple prior SAVRs and high surgical risk. Advanced imaging techniques were crucial in procedural success, ensuring precise device placement. A multidisciplinary heart team approach is essential for optimizing outcomes in complex valve pathology. Long-term follow-up is necessary to monitor the durability of the closure and potential complications.
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Sacra et al. (2025) conducted a case report in Paravalvular leak regurgitation after recurrent prosthetic valve endocarditis (n=1). Transcatheter paravalvular leak closure (Occlutech paravalvular leak device) was evaluated on Reduction of paravalvular leak regurgitation. Transcatheter paravalvular leak closure using an Occlutech device successfully reduced moderate-to-severe regurgitation to a trace-mild leak in a high-risk patient with multiple prior surgeries.
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