Preoperative FluoroCT imaging -guided transapical closure of mitral paravalvular leak: a case report

Background: Mitral paravalvular leak (PVL) is a recognized complication following prosthetic valve replacement, associated with heart failure, hemolysis, and increased morbidity. While redo surgery is the traditional treatment, transcatheter closure has emerged as a less invasive alternative, particularly in high-risk surgical candidates. Here, we present a case of preoperative FluoroCT imaging planning for transapical closure of mitral PVL. Case presentation: A 57-year-old female with prior double mechanical valve replacement (mitral and aortic) presented with worsening exertional dyspnea and fatigue.Transesophageal Echocardiography (TEE) identified a 5 mm posterior paravalvular leak adjacent to the mitral sewing ring. Preoperative contrast-enhanced CT analyzed with FluoroCT imaging software localized the leak to the 4-5 o'clock position and provided the optimal C-arm projection (cranial 48°, left anterior oblique 8°). Transapical closure via a left mini-thoracotomy was performed, and a 10 mm Ventricular Septal Defect occluder (Huayishengjie Medical Company, Beijing, China) was successfully deployed under TEE and fluoroscopic guidance. The patient had no residual leak, and total procedure time was 1 hour. Conclusions: FluroCT imaging-guided preoperative CT planning enables accurate localization of PVL and optimal fluoroscopic projection, reducing procedure time and improving safety. Transapical closure remains a feasible and effective approach for posterior mitral PVL in complex double-valve patients.