A081 Percutaneous Closure of a Rapid Deployment Aortic Valve Paravalvular Leak Using Intracardiac Echocardiography

Abstract

Paravalvular leak (PVL) is associated with poor outcomes and may be more common following rapid deployment valves. We present the first reported percutaneous closure of such a PVL using intracardiac echocardiography (ICE). A 76 year-old man underwent aortic valve replacement with 27mm Edwards Intuity rapid deployment valve in October 2018 for severe aortic stenosis. During follow-up, he developed worsening breathlessness (NYHA Class III) and diastolic murmur. Blood tests revealed elevated brain natriuretic peptide (189pmol/L) and evidence of haemolysis (haemoglobin 95g/L, bilirubin 34mmol/L, lactate dehydrogenase 800U/L, haptoglobin <0.07g/L). Transoesophageal echocardiogram confirmed moderate-severe paravalvular aortic regurgitation through a crescent-shaped defect. His case was discussed at the heart team meeting and percutaneous closure was recommended. The procedure was performed under local anaesthetic using fluoroscopic and ICE guidance. Two 8Fr femoral arterial and one 10Fr femoral venous sheath were used for access. The ICE catheter (10Fr Siemens AcuNav) was positioned in the right atrium to localise and measure the defect size at 20x3mm. This was closed using two overlapping 12x5mm Amplatzer Vascular Plug-III (Abbott, USA) devices, deployed simultaneously. Excellent result was confirmed on ICE, with stable device position and trivial residual leak. Arterial sites were closed using Terumo Angio-Seals and femoral vein by manual compression. There were no procedural complications. The patient had significant clinical and biochemical improvement. Percutaneous closure of rapid deployment aortic valve paravalvular leak with ICE guidance appears safe and effective; and may obviate the need for general anaesthesia.