Transcatheter Device Closure of Complex Paravalvular Leak after Bioprosthetic and Mechanical Pulmonary Valve replacement in Two Adult Patients

AUTHORS

Zahra Khajali ORCID 1 , Ata Firouzi ORCID 1 , Maryam Keshavarz Hedayati ORCID 2 , * , Fateme Jorfi ORCID 3 , Mohamad Sadra Nazari ORCID 2

1 Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran

2 Buali Sina Medical and Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran

3 Imam Khomeini Medical and Research Center, Jundishapour University of Medical Sciences, Ahwaz, IR Iran

How to Cite: Khajali Z, Firouzi A , Keshavarz Hedayati M, Jorfi F, Nazari M S. Transcatheter Device Closure of Complex Paravalvular Leak after Bioprosthetic and Mechanical Pulmonary Valve replacement in Two Adult Patients, Int Cardio Res J. 2020 ; 14(4):e102248.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 14 (4); e102248
Published Online: September 01, 2020
Article Type: Case Report
Received: September 15, 2020
Accepted: May 27, 2020
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Abstract

Introduction: Paravalvular leak after prosthetic valve operation affects up to 27% of
all prosthetic heart valves implanted by conventional surgery, which can be the cause
of serious complications like hemolysis and congestive heart failure. Surgical reintervention
is the conventional treatment of choice for severe cases, but it is associated
with significant morbidity and mortality and is not always successful because of
underlying tissue fragility. Over the last decade, transcatheter treatment of paravalvular
leaks has emerged as an attractive alternative to surgery for high-risk patients and is now
favored as the initial approach in some experienced centers. Significant paravalvular
leaks are not common following a pulmonary valve replacement and may be more
complex anatomically than left‐sided paravalvular leak due to the variability in implant
location and technique in the trabeculated and often dilated and fibrotic right ventricular
outflow tract.
Case Presentation: This study aimed to report two patients with successful transcatheter
closure of a complex paravalvular leak utilizing Ventricular Septal Defect (VSD)
and Patent Ductus Arteriosus (PDA) occluder devices following mechanical and
bioprosthetic Pulmonary Valve Replacement (PVR). The cases included a 34‐year‐old
and a 26-year-old man who were known cases of tetralogy of Fallot with a history of total
correction operation (TFTC).
Conclusions: The results showed that paravalvular leak could be a hemodynamically
serious complication of surgical PVR and that transcatheter device closure was an
acceptable way for the relief of these defects. However, the best approach for the closure
of pulmonary paravalvular leak depends on specific anatomic structures and the origin
or course of the coronary arteries that must be evaluated before device implantation.

© 0, Shiraz University of Medical Sciences.

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