Successful Transcatheter Amplatzer Repair of Severe Paravalvular Leak Following Mechanical Mitral Valve Replacement Surgery.

INTRODUCTION: Paravalvular leaks are a rare complication following surgical mitral valve replacement but may result in significant mitral regurgitation. In patients with paravalvular leak, percutaneous repair of the leak is an emerging option for patients who are poor surgical candidates. This report presents a case of a severe symptomatic paravalvular leak postsurgical mitral replacement that was treated with a transcatheter approach resulting in complete resolution of paravalvular regurgitation and symptoms.

CASE DESCRIPTION: A 60-year-old male with a history of atrial fibrillation, nonischemic cardiomyopathy, Stage III chronic kidney disease, and heart failure with a mildly reduced ejection fraction that improved after undergoing mechanical mitral valve replacement presented with recurrent shortness of breath a few months after surgery. Transthoracic echocardiography demonstrated severe paravalvular leak, with a subsequent TEE confirming the precise etiology and location. After collaborative evaluation in a multidisciplinary valve clinic, the patient underwent successful transcatheter closure with Amplatzer plugs.

DISCUSSION: Transcatheter valve interventions are minimally invasive techniques that have emerged as therapeutic options for patients who are poor surgical candidates. Using this approach to manage PVL is now being studied as a treatment option for patients to avoid redo mitral surgery. This case presents a transcatheter approach to PVL closure in a patient who had undergone a previous surgical mitral valve replacement, resulting in complete resolution of symptoms. The effectiveness of this transcatheter approach signals the need for larger prospective or registry studies to refine transcatheter approaches to manage postsurgical mitral paravalvular leaks.