Transcatheter Closure of a Mitral Paravalvular Leak Using a Retrograde Approach and Arteriovenous Loop: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Mitral Paravalvular Leak (n=1). Intervention: Transcatheter paravalvular leak closure via retrograde approach with arteriovenous loop. Primary outcome: Reduction in paravalvular regurgitation, hemolysis markers (LDH), and heart failure symptoms.

Q: What does this research mean for the field?

Transcatheter closure of a mitral paravalvular leak using a retrograde approach and arteriovenous loop effectively reduces paravalvular regurgitation and alleviates hemolytic anemia when an antegrade transseptal approach fails. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yusuke Morita; Miho Nakamura; Keita Nakamura; Rifa So; Takeshi Serikawa; Hiroo Noguchi; Takeshi Arita

doi:10.33290/jtvt.cr.26-0016

January 1, 2026Journal of Transcatheter Valve TherapiesOpen Access

Transcatheter Closure of a Mitral Paravalvular Leak Using a Retrograde Approach and Arteriovenous Loop: A Case Report

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Key result

Retrograde transcatheter mitral paravalvular leak closure successfully reduces regurgitation and cuts LDH by ~56%.

n=1

Why the study?

Paravalvular leak is a serious complication after surgical valve replacement with high operative risks for redo surgery in elderly patients.

Key Points

To describe the transcatheter management of a significant mitral paravalvular leak in an elderly patient at high surgical risk following mechanical valve replacement.
An 86-year-old woman with symptomatic mitral paravalvular leak underwent transcatheter closure after failing an initial antegrade transseptal crossing due to non-coaxial alignment.
A retrograde approach via the left femoral artery was established across the aortic valve into the left ventricle, snaring a guidewire in the left atrium to build a stable arteriovenous loop.
A rectangular Occlutech Paravalvular Leak Device was deployed through the exteriorized loop across the crescent-shaped posterior defect under transesophageal echocardiographic guidance.
Transcatheter closure reduced paravalvular regurgitation from moderate-to-severe down to a mild level without interfering with mechanical valve leaflet motion.
Laboratory markers of hemolysis improved, with lactate dehydrogenase decreasing from 2096 U/L before the procedure to 927 U/L post-procedure and remaining at 1063 U/L at 1-month follow-up.
Heart failure symptoms resolved to New York Heart Association functional class II at 1 month, maintaining mild residual leak on transthoracic echocardiography.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

An 86-year-old woman with heart failure and severe hemolytic anemia due to a significant mitral paravalvular leak 30 years after mechanical mitral valve replacement, followed for 1 month.

I

Intervention

Transcatheter paravalvular leak closure using a retrograde approach via the left femoral artery, combined with an arteriovenous loop to deliver a rectangular Occlutech Paravalvular Leak Device.

O

Outcome

Reduction in paravalvular regurgitation, improvement in hemolysis markers (LDH), and improvement in heart failure symptoms (NYHA class).

When an antegrade transseptal approach fails to cross a posterior mitral paravalvular leak, conversion to a retrograde approach with an arteriovenous loop can enable successful transcatheter closure and symptom resolution.

Limitations

The Occlutech Paravalvular Leak Device was the only dedicated device approved and reimbursed for this procedure in Japan at the time, preventing comparisons with alternative devices.
Potential perceived bias due to the corresponding author's consultancy with the device distributor.
The Occlutech Paravalvular Leak Device was the only dedicated device approved and reimbursed in Japan at the time, limiting comparative device conclusions.
Potential perceived bias due to author consultancy with the device distributor.

Implication

May offer alternative for prohibitive-risk mitral PVL; leaves open need for confirmatory studies.

Abstract

Objective: Paravalvular leak (PVL) is a serious complication following surgical valve replacement that can lead to heart failure and hemolytic anemia. While redo surgery is a definitive treatment, it often carries prohibitive operative risks in elderly patients.

Discussion

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Cite This Study

Morita et al. (2026) conducted a case report in Mitral Paravalvular Leak (n=1). Transcatheter paravalvular leak closure via retrograde approach with arteriovenous loop was evaluated on Reduction in paravalvular regurgitation, hemolysis markers (LDH), and heart failure symptoms. Transcatheter closure of a mitral paravalvular leak via a retrograde approach and arteriovenous loop successfully reduced paravalvular regurgitation to mild, and decreased LDH levels from 2096 to 927 U/L.

synapsesocial.com/papers/6ad0fce415427f6a840403bf https://doi.org/10.33290/jtvt.cr.26-0016

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Transcatheter Closure of a Mitral Paravalvular Leak Using a Retrograde Approach and Arteriovenous Loop: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Transcatheter Closure of a Mitral Paravalvular Leak Using a Retrograde Approach and Arteriovenous Loop: A Case Report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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