Percutaneous Closure of Aortic and Mitral Paravalvular Leaks—Diagnostic and Therapeutic Considerations

Abstract

Paravalvular leak (PVL) represents a suboptimal procedural outcome resulting in an eccentric regurgitant jet following surgical or transcatheter aortic or mitral valve replacements. In this review, the role of integrated imaging modalities, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, for the diagnosis and evaluation of aortic and mitral PVL is comprehensively discussed. Interventional procedures for aortic or mitral PVL using various percutaneous closure devices are reviewed. Clinical outcomes of percutaneous closure of PVL in aortic and mitral valves are summarized. PVL occurs in 6% to 15% of aortic valve and 7% to 17% of mitral valve procedures. Percutaneous device closure of PVL has shown an improved survival benefit. Successful reduction in PVL is associated with improved clinical outcomes. Multimodal imaging and inter-disciplinary discussion are essential for a high success rate of percutaneous closure of PVL. Further research on the pathophysiology of PVL and factors affecting complications are needed. A PVL closure device with various available shapes might be helpful for increasing procedural success rates.