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

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.