Article

Images in cardiology

REC Interv Cardiol. 2021;3:234-235

Percutaneous closure of multiple mitral paravalvular leaks

Cierre percutáneo de múltiples fugas paravalvulares de prótesis mitral

Marcelo Gómez Silva,a, Ignacio Cruz González,b Rodrigo Muñoz Di Vanni,c,d Rocío González Ferreiro,b, Luis Javier Rodríguez Collado,b and Jean Núñez Garcíab

aUnidad de Hemodinámica, Hospital Dr. Gustavo Fricke, Viña del Mar, Valparaíso, Chile

bUnidad de Hemodinámica, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

cUnidad de Hemodinámica, Hospital Dr. Sótero del Río, Santiago, Chile

dClínica Alemana, Vitacura, Santiago, Chile

Sixty-six-year-old male patient with a past medical history of mitral and aortic valve replacement in 1983. Back in 2005 he underwent a new aortic valve replacement due to prosthetic valve dysfunction. In 2018, also due to prosthetic valve dysfunction, a new mitral valve replacement was performed with a size 27 Bicarbon Fitline heart valve (Sorin Group, Italy).

Three months later the patient was hospitalized with functional class III-IV heart failure according to the New York Heart Association (NYHA) and hemolytic anemia with multiple mitral paravalvular leaks quantified as severe regurgitation. In a single medical-surgical session it was decided to perform percutaneous treatment due to the patient’s high surgical risk. The percutaneous closure of the leaks was performed using 7 Amplatzer Vascular Plug III devices (figure 1E) that resulted in minimal residual leaks.

In 2019 the patient presented with NYHA functional class III-IV and hemolytic anemia back again. The 3D echocardiogram performed revealed the presence of 2 severe mitral paravalvular leaks (figure 2A,B) (video 1 of the supplementary data). Percutaneous approach was attempted. An antegrade venoarterial circuit via transseptal puncture was built using a 0.035 in hydrophilic guidewire (figure 1A,B) (videos 2 and 3 of the supplementary data), 2 12/5 mm Amplatzer Vascular Plug III devices were implanted (figure 1C) (videos 4 and 5 of the supplementary data), and 9 devices of the same type surrounding the prosthetic circumference (figure 1D and figure 2D) (video 6 of the supplementary data). The procedure was completed uneventfully. The transesophageal echocardiography performed during the procedure confirmed the reduction of mitral paravalvular leaks now quantified as mild regurgitation (figure 2C) (video 7 of the supplementary data). Disease progression was good, and the patient was discharged with NYHA functional class II-III, corrected anemia (hemoglobin of 12 g/dL), and outpatient follow-up.

Figure 1.

Figure 2.

CONFLICTS OF INTEREST

I. Cruz Gónzalez is proctor for Abbott.

SUPPLEMENTARY DATA


Video 1. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

Video 2. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

Video 3. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

Video 4. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

Video 5. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

Video 6. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

Video 7. Gómez Silva M. DOI: 10.24875/RECICE.M20000166.

* Corresponding author: Unidad de Hemodinámica, Hospital Dr. Gustavo Fricke, Avda. Álvarez 1532, Viña del Mar, Valparaíso, Chile.

E-mail address: marceloalejandro.gomezsilva@gmail.com (M. Gómez Silva).

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