Management Strategies of Paravalvular Leak in the Post-Transcatheter Aortic Valve Replacement Patient

Figure 1. Cardiac Computed Tomography to Assess Prosthetic Valve Size Expanded prosthetic valve at 22 mm with a paravalvular leak gap of 2.2 to 2.3 mm.

Figure 2. Short Axis Transcatheter Heart Valve With Moderate-to-Severe Paravalvular Leak on Transesophageal Echocardiography

Figure 3. Noncontrast Cardiac Computed Tomography Without Evidence of Leaflet Calcification

Figure 4. Contrast-Gated Cardiac Computed Tomography Showing No Evidence of Hypoattenuated Leaflet Thickening

Figure 5. Retrograde Wiring of Paravalvular Leak With the Glidewire Arterial to Arterial Rail Attempt to Deploy the 8-mm Amplatzer Vascular Plug II

Figure 6. 8-mm Mustang Balloon Inflation to Deliver the 7-F Destination Sheathe Antegradely

Figure 7. Vascular Plug Delivered Antegradely Without Release

Figure 8. Paravalvular Leak Valvuloplasty Using a 24-mm True balloon Vascular plug not yet released.

Figure 9. Final Aortogram Demonstrating Trace Residual Paravalvular Leak

Figure 10. Repeat Transesophageal Echocardiography Demonstrating Trace Residual Central Regurgitation

Figure 11. Contrast-Gated Computed Tomography Showing 35% Systolic Phase of the Native Annulus is Within the Instructions for Use of the Valve

Figure 12. Gated Contrast Computed Tomography With Valve Expansion Inflow, mid-stent, and outflow showing valve underexpansion with a mean area of 370 mm2 and a mean derived diameter of 21.7 mm.