Transcatheter closure of paravalvular leakage through multiple approaches after surgical mechanical valve replacements: A retrospective study

Figures

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  Figure 1.. The types of perivalvular leakage and the approach of interventional closure in 64 patients.

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  Figure 2.. Preoperative 3D printing model and simulator were used to simulate the interventional occlusion process. (A) The whole aortic root model was established by 3D printing technology. (B–D) After placing the occluder at the perivalvular leakage position in vitro, the position of the occluder and its relationship with the mechanical valve from different angles was observed.

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  Figure 3.. Angiography profiling transcatheter closure of an aortic mechanical PVL. (A) Ascending aorta angiogram to profile the para-aortic regurgitation. (B) Retrograde crossing of the PVL with a guidewire. (C) Retrograde crossing of the PVL with a guidewire. (D) Adjust the perspective angle to confirm that the guide wire passes through PVL. (E) Occluder device placed at the position of the PVL. (F) Ascending aorta angiogram after deployment. PVL = percutaneous paravalvular leak.

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  Figure 4.. Angiography during the transcatheter procedure of mitral mechanical PVL closure via multiple approaches. Mini-invasive transapical approach. (A) The transapical access was obtained with a 6 Fr sheath. Left ventricular angiogram to profile the para-mitral regurgitation. (B) Left ventricular angiogram to profile the para-mitral regurgitation. (C) Guide wire through PVL. (D) Guide wire through PVL. Occluder placed at the position of the PVL. (E) The mitral PVL crossed retrogradely with the guidewire. (F) The occluder was deployed. PVL = percutaneous paravalvular leak.

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  Figure 5.. Clinical and laboratory examination results before and after the transcatheter procedures. (A) Improvement in New York Heart Association functional class during the 1-year follow-up period. (B) The left ventricular ejection fractions during the 1-year follow-up period. (C) NT-proBNP levels during the 1-year follow-up period. (D) The indirect bilirubin levels during the 1-year follow-up period.

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  Figure 6.. Echocardiography before the procedure and during the follow-up period. (A) 2-dimensional transesophageal echocardiography shows the mitral PVL before the procedure; the color jet shows the PVL regurgitation. (B) 3-dimensional transesophageal echocardiography shows the mitral PVL before the procedure. (C) 2-dimensional transesophageal echocardiography shows the occluder and no residual regurgitation during the follow-up period. (D) 3-dimensional transesophageal echocardiography shows the mitral PVL closed with the occluder (the yellow arrow shows the PVL. The red arrow shows the occluder). PVL = percutaneous paravalvular leak.

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  Figure 7.. Computed tomography angiography before the procedure and during the follow-up period. (A) The aortic PVL before the procedure, sagittal view. (B) The aortic PVL before the procedure, axial view. (C) The aortic PVL was closed using the occlude, sagittal view. (D) The aortic PVL was closed with the occlude, axial view (the yellow arrow points to the PVL. The red arrow indicates the occluder). PVL = percutaneous paravalvular leak.

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  Figure 8.. The interference of the occluder with the mechanical valve disc. (A) The mechanical mitral valve could not close because the occluder interfered with the mechanical valve disc. (B) The mechanical mitral valve could not open because the occluder interfered with the valvular disc. (C) The mechanical mitral valve closed normally with no interference. (D) The mechanical mitral valve could open normally because there was no interference. (E) The position of the occluder had changed and interfered with the valvular disc during the redo open operation after transcatheter closure. (F) The worn occluder was removed.