Transapical concomitant transseptal transcatheter closure of a giant mitral paravalvular leak under three-dimensional printing guidance.

Abstract

A mitral paravalvular leak (PVL) is a significant complication of surgical valve replacement that has a profound impact on the health and survival of patients. Transcatheter closure of PVL has emerged as a promising treatment option. We present the case of a 65-year-old patient who experienced exertional dyspnea, chest tightness, and peripheral edema (New York Heart Association functional class Ⅵ) following surgical aortic and mitral valve replacement. Echocardiography and computed tomography performed on admission revealed a giant mitral PVL (1 bundle, volume 25.0 mL, area 13.0 cm²). Due to the patient's high surgical risk and complex anatomical characteristics, a patient-specific three-dimensional printed model was utilized to visualize anatomical structures and simulate the main procedures. After careful consideration, the surgical team opted to perform transcatheter closure of the giant mitral PVL via a transapical concomitant transseptal approach using two carefully selected devices of different sizes (14-mm and 16-mm Amplatzer Vascular Plug II). The procedure was carried out successfully. During the 1-month follow-up, the patient remained asymptomatic (New York Heart Association functional class Ⅰ). Transcatheter closure of a giant and complex mitral PVL utilizing three-dimensional printing guidance has proven to be a feasible approach.