Transcatheter Management of a Mitral Paravalvular Leak and an Adjacent Large Left Ventricular Pseudoaneurysm Using a Covered Stent-Nitinol Occluder Combination.

Paravalvular leak (PVL) and left ventricular pseudoaneurysm can develop after surgical valve replacement, often as a result of suture dehiscence and annular disruption, potentially causing refractory heart failure. While re-operation poses a high risk, transcatheter PVL management remains equally difficult due to the possibilities of device instability and interference with mechanical prosthesis leaflets. We present an early postoperative mitral PVL that was connected to a large left ventricular pseudoaneurysm, in which standard PVL closure devices would have restricted leaflet movement. A novel transcatheter approach was developed with virtual reality simulation, and implemented through a combined transseptal and percutaneous transapical access to deploy a covered stent across the PVL for exclusion of the pseudoaneurysm, followed by device closure of the stent lumen.