case_images: PMC11733582_01
case_images: PMC11733582_02
case_images: Case 2 Paravalvular Leak Evaluation and Final Result. (A) Transesophageal evaluation of paravalvular leak evidencing a mild paravalvular leak. (B and C) Final angiographic and echocardiographic result after percutaneous plugging.
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case_images: PMC11733582_02_gr1.jpg
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case_images: It revealed a normal LV size with a normally functioning bioprosthesis and highlighted an eccentric, posteriorly directed, mild PVL (Figures 1A to 1C, Video 2). Safari small. Post-dilatation with a 25-mm, then 26-mm True Balloon resulted in an unsatisfactory reduction of the PVL grade. Subsequently, a 7-mm Amplatzer Muscular VSD Occluder (Abbott Vascular) was deployed with the disks within the PVL tract, thereby reducing interaction with adjacent cardiac anatomy, mitigating the potential for hemolysis secondary to flow along the device, and resulting in a significant reduction in retrograde flow, as confirmed by intraprocedural TEE (Figures 1A to 1C, Video 2). The echocardiographic follow-up confirmed the persistence of a good result with a trace PVL (Figures 1A to 1C, Video 2).
case_images: PMC11733582_03
case_images: Case 3 Paravalvular Leak Evaluation and Final Result. (A) Transesophageal echocardiographic evaluation of paravalvular leak after index transcatheter aortic valve replacement evidencing a mild paravalvular leak. (B) Final angiographic view after redo transcatheter aortic valve replacement in an attempt to resolve the paravalvular leak. (C) Transesophageal echocardiographic evaluation of a paravalvular leak after redo transcatheter aortic valve replacement evidencing a persistent significant paravalvular leak. (D) Angiographic result after percutaneous plugging. (E) Postprocedural transesophageal echocardiographic evaluation with only a trace paravalvular leak. (F) Follow-up transthoracic echocardiogram with no evidence of paravalvular leak.
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case_images: PMC11733582_03_gr2.jpg
case_images: fig2
case_images: TTE revealed a mean gradient of 19 mm Hg and moderate PVL characterized by 3 jets, with a total circumferential extent of >10% (Figures 2A to 2F, Video 3). To address these complications, the patient underwent a transcatheter aortic valve (TAV)-in-TAV procedure using a 23-mm Sapien 3 Ultra and post-dilated with a 23-mm True Balloon. After multidisciplinary consultation with the hematology/oncology team, a decision was made to address the issue by closing the PVL (Figures 2A to 2F, Video 3). Additionally, echocardiographic evaluations showed no signs of recurrent PVL (Figures 2A to 2F, Video 3).