Transcatheter Device Closure of Complex Paravalvular Leak after Bioprosthetic and Mechanical Pulmonary Valve replacement in Two Adult Patients

Zahra Khajali; Ata  Firouzi; Maryam Keshavarz Hedayati; Fateme Jorfi; Mohamad Sadra Nazari

International Cardiovascular Research Journal

The Official Annually Journal of Cardiovascular Research Center, Shiraz University of Medical Sciences

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Transcatheter Device Closure of Complex Paravalvular Leak after Bioprosthetic and Mechanical Pulmonary Valve replacement in Two Adult Patients

Author(s):

Zahra Khajali

¹,

Ata Firouzi

¹,

Maryam Keshavarz Hedayati

^2,*,

Fateme Jorfi

³,

Mohamad Sadra Nazari

²

1Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran

2Buali Sina Medical and Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran

3Imam Khomeini Medical and Research Center, Jundishapour University of Medical Sciences, Ahwaz, IR Iran

International Cardiovascular Research Journal:Vol. 14, issue 3; e102248

Published online:Sep 01, 2020

Article type:Case Report

Received:Feb 27, 2020

Accepted:May 27, 2020

How to Cite:Zahra KhajaliAta FirouziMaryam Keshavarz HedayatiFateme JorfiMohamad Sadra NazariTranscatheter Device Closure of Complex Paravalvular Leak after Bioprosthetic and Mechanical Pulmonary Valve replacement in Two Adult Patients.Int Cardiovasc Res J.14(3):e102248.

Abstract

Introduction:
Paravalvular leak after prosthetic valve operation affects up to 27% of all prosthetic heart valves implanted by conventional surgery, which can be the cause of serious complications like hemolysis and congestive heart failure. Surgical re-intervention is the conventional treatment of choice for severe cases, but it is associated with significant morbidity and mortality and is not always successful because of underlying tissue fragility. Over the last decade, transcatheter treatment of paravalvular leaks has emerged as an attractive alternative to surgery for high-risk patients and is now favored as the initial approach in some experienced centers. Significant paravalvular leaks are not common following a pulmonary valve replacement and may be more complex anatomically than left‐sided paravalvular leak due to the variability in implant location and technique in the trabeculated and often dilated and fibrotic right ventricular outflow tract.
Case Presentation:
This study aimed to report two patients with successful transcatheter closure of a complex paravalvular leak utilizing Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) occluder devices following mechanical and bioprosthetic Pulmonary Valve Replacement (PVR). The cases included a 34‐year‐old and a 26-year-old man who were known cases of tetralogy of Fallot with a history of total correction operation (TFTC).
Conclusions:
The results showed that paravalvular leak could be a hemodynamically serious complication of surgical PVR and that transcatheter device closure was an acceptable way for the relief of these defects. However, the best approach for the closure of pulmonary paravalvular leak depends on specific anatomic structures and the origin or course of the coronary arteries that must be evaluated before device implantation.

Keywords

Septal Occluder Device

Congenital Heart Disease

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