Transcatheter Mitral Paravalvular Leak Closure With a Multifunctional Ventricular Septal Defect Occluder

BACKGROUND: Paravalvular leak (PVL) after surgical mitral valve replacement is an uncommon but clinically significant complication. Redo surgery carries a high risk, making transcatheter closure a viable and less invasive alternative. CASE SUMMARY: We report 2 cases of mitral PVL following prior surgical valve replacement who presented with signs and symptoms of heart failure. After echocardiographic evaluation, a transcatheter approach was undertaken to deploy a Konar-multifunctional (MF) ventricular septal defect (VSD) occluder under fluoroscopic guidance. Following the procedure, both patients showed significant clinical improvement with complete resolution of PVL. DISCUSSION: This case series emphasizes the feasibility and favorable outcome of transcatheter closure using the Konar-MF VSD occluder, off-label as an alternative to redo surgery in high-risk surgical patients with mitral PVL. Larger studies are warranted to evaluate the safety and efficacy of this off-label approach across a broader patient population. TAKE-HOME MESSAGES: New-onset symptoms of heart failure and hemolytic anemia even after years of surgical mitral valve replacement warrant careful and timely evaluation for PVLs. In select high-risk patients who are not ideal candidates for redo surgery, off-label use of the Konar-MF VSD occluder is a feasible alternative for closure of PVLs.