Key result
Late balloon valvuloplasty resolves paravalvular leak from focal underexpansion 4 months post-TAVR.
Why the study?
Late detection of paravalvular leak after TAVR presents unique treatment challenges, particularly in bicuspid valves due to valve geometry and percutaneous anchoring mechanisms.
Does late balloon valvuloplasty improve paravalvular leak in a patient with a bicuspid aortic valve post-TAVR?
Case Report (n=1)
Does late balloon valvuloplasty improve paravalvular leak in a patient with a bicuspid aortic valve post-TAVR?
Late balloon valvuloplasty is a safe and feasible option for treating paravalvular leak due to underexpanded TAVR in bicuspid valves.
Late PVL after bicuspid TAVR warrants extended surveillance; this case leaves open optimal percutaneous strategies pending prospective data.
BACKGROUND: Late detection of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) presents unique treatment challenges, especially in bicuspid valves, likely because of valve geometry and the mechanism of percutaneous anchoring. CASE SUMMARY: A 70-year-old man underwent TAVR for bicuspid aortic stenosis using a balloon-expandable valve. Moderate to severe PVL was detected 4 months later. A multidisciplinary team evaluated the PVL etiology, patient anatomy, and available treatment options including valve-in-valve and plug closure. A partially fused commissural raphe causing focal underexpansion was identified as the origin of PVL, and late balloon valvuloplasty was performed successfully. DISCUSSION: Unlike surgical-valve PVL, where percutaneous plug closure is the main treatment option, post-TAVR PVL offers additional approaches. Multimodality imaging helps define mechanism, feasibility, and risk. TAKE-HOME MESSAGES: Late balloon valvuloplasty is a safe option for underexpanded TAVR in bicuspid valves. Assessment of calcified raphe anatomy and the underexpansion site guides procedural risk and informs treatment selection.
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Mosaad et al. (2026) conducted a case report in Paravalvular leak after TAVR in a bicuspid aortic valve (n=1). Late balloon valvuloplasty was evaluated on Successful treatment of paravalvular leak. Late balloon valvuloplasty successfully treated moderate to severe paravalvular leak caused by focal underexpansion 4 months after TAVR in a 70-year-old man with a bicuspid aortic valve.
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