June 12, 2026Catheterization and Cardiovascular Interventions0 citations
View Full PaperPrison Break: Extraction of a Plug Jailed Between Two Mechanical Valves
Key Result
Percutaneous retrieval of an embolized Amplatzer Vascular Plug III through a mechanical prosthesis, followed by immediate re-closure of the paravalvular leak, successfully restored valve function.
Key Points
- This case aims to address the management of paravalvular leak and the implications of device migration in patients at high surgical risk.
- Reported case of a 37-year-old woman with recurrent heart failure due to mitral paravalvular leak.
- Performed transcatheter closure with Amplatzer Vascular Plug III devices; followed by retrieval of an embolized device through the aortic valve and immediate re-closure of the leak.
- Evaluated hemodynamic stability post-intervention.
- Achieved substantial reduction of regurgitation after initial transcatheter closure.
- Addressed acute pulmonary edema by retrieving the migrated device while restoring valve function immediately thereafter.
- Successfully demonstrated the feasibility of advanced bailout strategies in patients with prohibitive surgical risks.
Study Design
Type
Case Report (n=1)
Structured PICO
P
Population
1 37-year-old woman with prior mechanical mitral and aortic valve replacements, complicated by recurrent heart failure due to a mitral paravalvular leak (PVL) resulting from suture dehiscence.
I
Intervention
Percutaneous retrieval of an embolized Amplatzer Vascular Plug III device from the left ventricular outflow tract, followed by immediate re-closure of the PVL.
O
Outcome
Restoration of valve function and hemodynamic stability
This case demonstrates the feasibility of percutaneous retrieval of an embolized paravalvular leak closure device through a mechanical prosthesis and immediate re-closure in a patient at prohibitive surgical risk.
Abstract
Paravalvular leak (PVL) occurs in up to 17% of prosthetic valve replacements, mainly in the mitral position. Surgery is the gold standard but carries high morbidity in patients with a history of previous sternotomies. Transcatheter closure of PVL offers a minimally invasive alternative with a very high success rate. Device migration, while uncommon, can be catastrophic when impinging on mechanical prosthetic valve performance. We report the case of a 37-year-old woman with prior mechanical mitral and aortic valve replacements, complicated by recurrent heart failure due to a mitral PVL resulting from suture dehiscence. Initial transcatheter closure with two Amplatzer Vascular Plug III devices achieved a substantial reduction of regurgitation. Four months later, she presented with acute pulmonary edema caused by migration of one device into the left ventricular outflow tract, intermittently obstructing a mechanical aortic valve leaflet. Given her prohibitive surgical risk, percutaneous retrieval was undertaken, followed by immediate re-closure of the PVL during the same procedure, successfully restoring valve function and hemodynamic stability. This case illustrates the complexity of late PVL management after mechanical mitral valve replacement and highlights the potential risk of device migration. While surgery remains the gold standard, percutaneous intervention represents the only viable option in patients at prohibitive surgical risk. To our knowledge, this is the first reported case of successful percutaneous retrieval of an embolized device through a mechanical prosthesis, followed by re-closure of the PVL within the same procedure. This experience underscores the feasibility of advanced bailout strategies in carefully selected patients.