Percutaneous Closure of Mitral Paravalvular Leak Guided by Three-Dimensional Transesophageal Echocardiography

Reoperation is the method of choice for correcting prosthetic paravalvular leaks. The percutaneous repair of mitral paravalvular leaks might represent an interesting alternative in select cases. The present study reports two cases of mitral paravalvular leaks that were treated with AmplatzerTM Vascular Plug III guided by three-dimensional (3D) transesophageal echocardiography, using the percutaneous approach. The first case involved a 55-year-old male who had undergone five cardiac surgeries (aortic and mitral valve replacements) and presented with New York Heart Association (NYHA) class III heart failure and severe mitral regurgitation. The second case was a 76-year-old male who had undergone two aortic valve replacements; the last procedure was associa ted with mitral valve replacement, which developed into NYHA class IV heart failure and severe mitral regurgitation. This patient had several comorbidities that increased his surgical risk. The procedures were performed percutaneously under general anaesthesia, using the transseptal approach to deploy the plugs, which occluded the paravalvular defects successfully in both cases. DESCRIPTORS: Mitral valve. Heart valve prosthesis. Heart valve prosthesis implantation. Transesophageal echocardiography. Three-dimensional echocardiography. 1 Cardiology specialist in the Brazilian Society of Cardiology. Resident physician in the haemodynamics department at the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil. 2 Cardiology specialist in the Brazilian Society of Cardiology. Resident physician in the haemodynamics department at the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil. 3 Assistant physician in the echocardiography department at the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil. 4 Assistant physician in the echocardiography department at the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil. 5 PhD in Science from the Faculdade de Medicina da Universidade de São Paulo. Head of the haemodynamics department at the Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brazil. Case Report