Percutaneous Paravalvular Leak Closure

Paravalvular regurgitation affects 5–17 % of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with symptoms arising from ongoing haemolysis or heart failure. Re-operation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation or calcification. Percutaneous paravalvular leak closure is now an established therapy for symptomatic patients (available to view at www.mici.education). Comprehensive echocardiographic imaging with transthoracic echocardiography and three-dimensional transoesophageal echocardiography is key in characterizing defect location, size and shape. With careful anatomical assessment, procedural planning and execution, successful closure rates of 90 % or more are attainable with a low risk of device impingement on the prosthetic valve or embolization.