Author + information
- Wei-Hsian Yin1
Patient initials or identifier number
Relevant clinical history and physical exam
68-year-old gentleman Chief complaint: progressive worsening of dyspnea on exertion for 5 months (NYHA functional class II-III)Past history: mitral valve prolapse with infective endocarditis and severe mitral regurgit-ation s/p mitral valve replacement (Edwards pericardial valve 29 mm) 2 years ago.Physical examination: regular heart beat, S1S2S3-S4-, grade 3/6 pansystolic murmur over apex, no peripheral pitting edema.
Relevant test results prior to catheterization
Preserved LV & RV systolic function.
Thickened aortic valve with mild AR.
Bioprosthetic mitral valve with severe paravalvular leak: 4 mmHg MPG, 16 mmHg PPG, MVA= 2.4cm2 by PHT.
Oval-shape defect about 4-5mm at mitral-aortic fibrous continuity
Mild to moderate TR, RVSP= 45 mmHg.
Relevant catheterization findings
preserved LV systolic function, severe mitral paravalvular leak, dilated left atrium.
1. Retrograde approach via common femoral artery
2. Under the guidance of fluoroscopy and TEE, 0.025” guidewire passed through the mitral paravalvular leak but 6F JR4 guiding catheter failed.
3. With the support of double wires and mother-in-child catheter, 5F multipurpose guiding catheter passed through the mitral para-valvular leak and then 6F JR4 guiding catheter passed through the mitral paravalvular leak.
4. We selected 6mm/4mm Amplatzer ductal occluder II (AGA Medical Corp, Plymouth, MN, USA) to plug the leak.
5. Amplatzer ductal occluder II was deployed and only mild residual leak was detected by TEE.
Although surgical repair or replacement is the gold standard for treatment of prosthetic paravalvular leakage, it carries a high morbidity and mortality risk, and some patients are poor surgical candidates. The percutaneous closure of such defects is an attractive alternative to surgery, and different devices are being used for this purpose. Afemorofemoral wire loop is usually constructed to deliver the closure device. In our case, a prosthetic mitral paravalvular leak was successfully closed with use of the Amplatzer® Duct Occluder II, via retrograde approach under the guidance of fluoroscopy and trans esophageal echocardiography, without the use of a wire loop.