Mitral Paravalvular Leak Closure Using a Percutaneous and Nonfluoroscopic Approach.

OBJECTIVE

Mitral paravalvular leak (PVL) is a serious complication after mechanical mitral valve replacement. We describe a step-by-step percutaneous and nonfluoroscopic (PAN) technique for mitral PVL closure guided exclusively by transesophageal echocardiography (TEE) to eliminate radiation exposure.

KEY STEPS: First, preprocedural anatomical assessment and device sizing use cardiac computed tomography and TEE. Next, under TEE guidance, transseptal puncture is performed, followed by steerable sheath positioning in the left atrium. Then, a guidewire is advanced across the defect, and a delivery sheath is positioned. Finally, an adequate working distance is established to ensure that the Amplatzer vascular plug is precisely deployed without interfering with the mechanical valve discs.

POTENTIAL PITFALLS: The PAN approach relies on high-quality TEE windows; suboptimal imaging or complex, calcified leaks may require fluoroscopic assistance.

TAKE-HOME MESSAGE: The PAN approach for mitral PVL closure is a feasible and precise strategy that eliminates ionizing radiation while maintaining procedural safety in selected patients.