Percutaneous treatment of multi-valvular paraprosthetic leaks in a “fragile” heart

Abstract

A 38-year-old male with osteogenesis imperfecta, had a history of mitral and aortic dysplasia with severe regurgitation requiring surgical valve replacement followed by two further reoperations due to the development of recurrent paravalvular leaks. Two months after his last intervention he presented with clinical signs of acute decompensated heart failure. Echocardiography showed multiple para-valvular leaks with both severe mitral and aortic periprosthetic regurgitation (Fig. 1). As the patient was deemed too high risk for further multiple valve surgery, a transcatheter percutaneous leak closure was performed with implantation of 3 Amplatzer Vascular Plug (St. Jude Medical Corp, St. Paul, MN, USA) 10 mm devices in the aortic leaks and 2 Amplatzer Vascular Plug II devices, 20 mm and 16 mm in the perimitral defect. After two years of clinical stability, he was readmitted for increasing dyspnoea (NYHA Class IV) and ankle swelling. Echocardiogram showed good function of both prosthetic valves with well-positioned plugs, but significant residual paravalvular leaks were still present (Fig. 2, Video 1). Fig. 2Panel A: At three-dimensional transesophageal echocardiography the two peri-mitral plugs (asterisks), with significant residual regurgitation, are imaged. Panel B: Transthoracic echocardiogram showing the periprosthetic plugs in aortic position with residual moderate regurgitation. View Large Image Figure Viewer Download Hi-res image