Closure of a Para-valvular Aortic Leak: with the Use of 2 AMPLATZER Devices and Real-Time 2? and 3-Dimensional Transesophageal Echocardiography

摘要

Paravalvular leaks are well-recognized sequelae of mechanical aortic valve implantation. Clinical manifestations include hemolysis, arrhythmias, and congestive heart failure. Frequently, patients who receive mechanical aortic valves are poor candidates for repeat valve surgery, and the reoperative mortality rate is high. Percutaneous intervention has recently become an alternative to surgery in selected patients. Herein, we describe the percutaneous closure of an aortic paravalvular leak in a 45-year-old man who had undergone 2 aortic valve replacements with mechanical valves. The patient, who was at high surgical risk due to comorbidities, underwent the implantation of 2 AMPLATZER devices with the use of real-time 2- and 3-dimensional transesophageal echocardiography. The early outcome of the procedure was favorable and without sequelae. To our knowledge, this is the 1st report of the closing of an aortic paravalvular leak with the use of 2 closure devices and real-time echocardiographic guidance. Key words: Aortic valve insufficiency/complications/diagnosis/etiology, echocardiography, transesophageal, heart catheterization, heart valve diseases/therapy/ultrasonography, heart valve prosthesis/adverse effects/standards, postoperative complications/therapy/ultrasonography, prosthesis failure, risk assessment, risk factors, treatment outcome Paravalvular leaks are well-recognized sequelae of mechanical aortic valve implantation. In 15% to 50% of cases, small paravalvular leaks are detected, but these are typically of minimal clinical significance. 1 In 1% to 5% of cases, however, the leaks are associated with hemolysis, arrhythmias, or congestive heart failure. 2–7 Patients who receive mechanical aortic valves can be poor candidates for repeat valve surgery: the reoperative mortality rate is as high as 15%. 6 Palliative medical therapy is largely intended to alleviate the symptoms of congestive heart failure. Recently, endovascular closure devices for structural and congenital heart disease have found an off-label use in the percutaneous repair of paravalvular leakage in selected high-risk surgical patients. In 64 reported cases, the overall short-term success rate was approximately 85%; repeat procedures were needed in approximately 25% of the patients. Over 70% of the described cases involved mitral paravalvular leaks. 1–5 Herein, we describe the percutaneous treatment of an aortic paravalvular leak with the use of real-time echocardiography to guide the implantation of 2 closure devices.