EComment. Percutaneous closure of prosthetic mitral paravalvular leaks with Amplatzer devices

Abstract

I have read with great interest the article by Smith et al. [1]. They address one of the most important potential complications of the closure of paravalvular valve leaks (PVL) with an Amplatzer septal occluder device. Indeed, we have previously also published the direct relationship between residual mitral PVL and its closure by means of septal occluder devices [2]. PVLs are a common finding in mitral valve surgery. They are detected in up to 28% of the cases of mitral valve replacement, mainly related to the surgical technique, and the incidence may be as high as 32% when transoesophageal echocardiogram is available and utilized for this purpose [3]. However, most of the PVLs are small and generally benign. Surgery is clearly indicated in patients requiring blood transfusions and those with congestive heart failure. This has been developed as an alternative treatment option avoiding redo operation, as mortality rate increases with the number of previous operations. Amplatzer occluders rarely close the defect entirely. In a series reported by Shapira et al. [4], a residual leak was observed in 90% of the cases after PVL closure with an Amplatzer occluder. This is probably due to the fact that this is a circular device not designed for PVL closure, which commonly exhibit a crescent shape. In an attempt to completely close the defect, larger occluders are utilized. The larger the Amplatzer occluder, the higher the probability of interference with the prosthesis. Merin et al. [5] reported a case of impingement of valve leaflet motion. In our case, both complications described above occurred [2]. These are excellent examples to demonstrate that current devices frequently used for transcatheter percutaneous closure of PVLs are not geometrically adapted to the anatomy of PVLs.