Olaf Franzen, MD1, Oliver Deutsch, MD2, Joachim Schofer, MD1, Christian Detter, MD2, Thomas Meinertz, MD1, Hermann Reichenspurner, MD, PhD2.
1University Heart Center, Department of Cardiology, Hamburg, Germany, 2University Heart Center, Department of Cardiovascular Surgery, Hamburg, Germany.
BACKGROUND: Paravalvular leaks (PVL) are a rare but well-recognized complication of prosthetic valve replacement. In most cases PVL are asymptomatic, but some may cause symptoms due to a large regurgitation volume or haemolysis. Since re-operation carries significant risk, there has been a growing interest in the attempt to close PVL through the use of percutaneous techniques with occluder-devices.
METHODS: Review of our experience with interventional percutaneous closure of PVL.
RESULTS: Between 2006 and 2007, six procedures were performed in six patients (age range 19-72; 5 male, 1 female). One bioprosthetic mitral and five aortic valve replacements (four mechanical and one bioprosthetic valve) were involved. In one case there was a ventricle septal defect following bioprosthetic aortic valve replacement and resection of a LVOT-obstruction. In another case there were multiple paravalvular jets following combined mechanical aortic and mitral valve replacement. In yet another case there were multiple paravalvular jets following mechanical aortic valve replacement with reduced left ventricular function and renal insufficiency after kidney transplantation. The devices used were self-expanding nitinol atrial septal and ventricle septal Amplatzer® occluders (AGA Medical Inc., Golden Valley, MN). Procedure time was 59-162 minutes whereas x-ray-examination-time was 30-89 minutes. Five patients (83%) had a successful single interventional procedure (minimal residual leak); in one case, the PVL could not be crossed with the catheter. This patient was reoperated successfully. All patients showed elevated lactate dehydrogenase (LDH) levels, as a sign of transient haemolysis after the intervention. However there was neither relevant decrease of haemoglobin (Hb) nor need for blood transfusions.
CONCLUSIONS: Interventional percutaneous closure of PVL is technically challenging but feasible in selected patients with good results. This novel approach for the repair of PVL should be considered to avoid lengthy re-operations in high-risk patients.
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