Paravalvular leak closure is a nonsurgical treatment to repair heart valve leaks that occur after valve replacement. Interventional cardiologists use PVL to safely repair leaks instead of repeating surgery, which can pose a higher risk to some people with heart disease. Transcatheter PVL closure is an imaging-intensive, technically nuanced intervention in which procedural endpoint quality (≤mild residual PVL without prosthetic interaction) is the dominant driver of clinical benefit.

Understanding the Context

We describe a novel and pragmatic approach to PVL closure by leveraging the misaligned diamond-shaped cell of an Evolut FX+ valve (Medtronic), highlighting procedural planning, technical execution, and key learning points. However, this is a condition that frequently presents after valvular replacement. This article will cover the diagnosising and treating PVL (i.e. imaging, access, and device selection).

Key Insights

In addition, specific aspects of aortic and mitral PVL closure will be covered in this review. Transcatheter PVL closure consists of placing a space-occupying device within the gap between annular tissue and the prosthetic valve, thus preventing flow through that space. Percutaneous PVL closure is an effective therapy for patients with heart failure or intractable hemolysis who are at high risk for surgery when performed in centers with expertise in this procedure. The current ACC/AHA guidelines recommend device closure of PVL in patients with symptomatic heart failure or persistent hemolytic anemia, provided they have suitable anatomy for percutaneous intervention. Paravalvular leak (PVL) is a seldomly covered aspect of structural heart disease.

Final Thoughts

However, this is a condition that frequently presents after valvular replacement. This article will cover the diagnosising and treating PVL (i.e. imaging, access, and device selection).