In this chapter of Tools and Techniques Clinical, paravalvular leak closure is discussed using a stepwise approach. The following is a summarised overview of this technique. The complete, unabridged version with images is available online at http://www. pcronline.com/eurointervention/70th_issue/227. Paravalvular leak (PVL) is a common problem for mechanical and bioprosthetic valves, occurring in 5-17% of implanted valves. The associated aortic or mitral regurgitation can be associated with haemolysis or heart failure, leading to increased morbidity and mortality. Surgical treatment is associated with a high mortality risk, especially for redo surgery. Indications for paravalvular leak closure include patients with significant regurgitation accompanied by symptoms of congestive heart failure and/or haemolysis. Important contraindications to PVL closure may include presence of active local or systemic infection, active ischaemia, mechanical instability of the prosthetic valve, intracardiac thrombus, and patients with a life expectancy due to comorbidities that is less than six months. This paper will focus on aortic and mitral PVL, with a look at a few special situations regarding these valves.
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