Percutaneous paravalvular leak repair for severe aortic regurgitation after transcatheter aortic valve implantation (TAVI)

Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement.The need for re-operation for clinically significant leaks is between 1 and 3%. 1 Percutaneous PVL closure has become increasingly performed and is an alternative to surgery. 1 PVLs occur more frequently after transcatheter aortic valve implantation (TAVI), as the transcatheter heart valve (THV) is anchored by radial force alone. 24][5][6][7][8][9] We report a case of heart failure due to severe PVL after TAVI that has been treated with percutaneous repair with a good 4-year clinical outcome.A 72-year-old man presented with exertional dyspnoea (New York Heart Association [NYHA] Class III) over 6 months.Echocardiography demonstrated a severely impaired left ventricular ejection fraction (LVEF) of 30% and severe paravalvular AR around a bioprosthetic valve (Fig. 1A).Transoesophageal echocardiogram (TEE) confirmed severe paravalvular AR with a pressure half-time of 213ms, holodiastolic reversal in the descending thoracic aorta, and PVL jet occupying 35% of the prosthesis circumference.The PVL defect width was approximately 6mm.