No Cut, Just Close: Transcatheter Device Closure of Mitral Paravalvular Leak
Kalyan Munde
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Gaurav Kothari *
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Prasad Jain
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Samkit Mutha
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Anant Munde
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Ruchit Shah
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Jaykrishna Nihari
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Salman Shaikh
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Khaleel Shaikh
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Vaishali Gaba
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Vighnesh Rane
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
Anil Kumar Gupta
Department of Cardiology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India.
*Author to whom correspondence should be addressed.
Abstract
Paravalvular leaks (PVLs) are increasingly recognized after valve replacement procedures, resulting from factors such as incomplete sealing, suture dehiscence, or annular calcification. Mitral PVLs are particularly common and can lead to symptoms ranging from mild dyspnea to severe heart failure. While surgical repair remains the traditional approach, transcatheter PVL closure has emerged as a less invasive alternative, offering comparable outcomes with reduced procedural risks. This technique is guided by advanced imaging modalities, with three-dimensional trans esophageal echocardiography (TEE) serving as the gold standard for assessing leak location, size, and severity. Recently, devices have been developed specifically for PVL closure, demonstrating high technical success rates and favorable post-procedural outcomes. The procedure can be performed via antegrade or retrograde approaches, depending on the leak's anatomy, and is associated with a low incidence of complications such as device embolization or stroke. Overall, percutaneous PVL closure represents a promising strategy, particularly for patients with suitable anatomy and contraindications to surgery, leading to significant improvements in symptoms and quality of life.
Keywords: Paravalvular leak (PVL), TEE, 3D TEE, heart failure, transcatheter closure, minimally invasive procedure