Mitral paravalvular leak
The blue arrow indicates a mitral paravalvular leak, which was closed by a device.
3D transesophageal ultrasound image of the mitral valve
White arrow: Mitral paravalvular leak.
Black arrow: device closing a mitral paravalvular leak.
Devices for paravalvular closures
PARAVALVULAR LEAK CLOSURE
What is a paravalvular leak?
This is a leak located next to your valve prosthesis, which results in a backflow of blood into the heart cavity upstream. The cause of this leak is a more or less extensive detachment of the prosthesis that was surgically implanted in you. This detachment may be of infectious origin (endocarditis) or mechanical (tissue fragility, suturing difficulties related to calcifications present on your valve). It may exist since the post-operative period or appear secondarily.
What are the consequences of a paravalvular leak?
The leak results in increased workload on the heart and can lead to symptoms related to heart failure. The leak can also lead to abnormalities in the red blood cells (hemolysis) and therefore anemia.
What are the possible consequences of a paravalvular leak?
Not all paravalvular leaks indicate intervention. An intervention was proposed to you if your leak was deemed significant and responsible for symptoms. The standard treatment is surgical. In some cases, surgery was considered risky by a multidisciplinary team (risks related to reintervention or risk of recurrence), and percutaneous occlusion of the leak orifice may be proposed. The feasibility of the procedure is assessed by a multidisciplinary team, using imaging tests (transesophageal ultrasound (TEE) and cardiac CT scan). These tests are used to plan the procedure (size of the occlusion device to choose, possible anatomical difficulties).
How is the percutaneous closure procedure performed? : The procedure will be performed under general anesthesia by a team of doctors trained in the technique. The team is composed of an anesthesiologist and a nurse anesthetist, two interventional cardiologists, an interventional sonographer and catheterization nurses. Given the technical nature of the procedure, a technical engineer mandated by the laboratory distributing the device may be present during your procedure. The procedure is guided by TEE. Anticoagulant treatment with heparin is administered at the beginning of the procedure and renewed if necessary during the procedure. Depending on the type of prosthesis affected, vascular access is via the femoral vein or artery. A guide is introduced to the location of the leak. Different catheters can be used to reach the orifice and cross it. The occlusion device is then introduced and deployed, the shape and size of which have been previously chosen using ultrasound evaluation. One or more devices may be required. The procedure lasts between 1.5 and 4 hours and requires general anesthesia. You will be hospitalized for a few days for monitoring and treatment adjustment.
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