DOI QR코드

DOI QR Code

Management of Recurrent Paravalvular Leakage in a Very High-Risk Patient: A Case Report

  • Park, Sung Jun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young Woong (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo, Jae Suk (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.08.13
  • Accepted : 2014.09.23
  • Published : 2015.02.05

Abstract

Interventional device closure has emerged as a less invasive alternative to surgery in the management of paravalvular leakage. However, this procedure involves various problems such as a high probability of residual leakage or hemolysis. Here, we report a case of residual paravalvular leakage despite two attempts at interventional closure in a patient with a history of four previous mitral valve replacements. The fifth operation for the primary repair of paravalvular leakage was performed successfully. Careful evaluation before the procedure and specially designed devices are essential for the interventional treatment of paravalvular leakage. Surgery can be performed adequately in the management of paravalvular leakage even in high-risk patients.

Keywords

References

  1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129:e521-643. https://doi.org/10.1161/CIR.0000000000000031
  2. Akins CW, Bitondo JM, Hilgenberg AD, Vlahakes GJ, Madsen JC, MacGillivray TE. Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks. J Heart Valve Dis 2005;14:792-9.
  3. Sorajja P, Cabalka AK, Hagler DJ, Rihal CS. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30-day outcomes in 115 patients. Circ Cardiovasc Interv 2011;4:314-21. https://doi.org/10.1161/CIRCINTERVENTIONS.110.960955
  4. Nietlispach F, Johnson M, Moss RR, et al. Transcatheter closure of paravalvular defects using a purpose-specific occluder. JACC Cardiovasc Interv 2010;3:759-65. https://doi.org/10.1016/j.jcin.2010.04.013
  5. Hourihan M, Perry SB, Mandell VS, et al. Transcatheter umbrella closure of valvular and paravalvular leaks. J Am Coll Cardiol 1992;20:1371-7. https://doi.org/10.1016/0735-1097(92)90250-Q
  6. Shapira Y, Hirsch R, Kornowski R, et al. Percutaneous closure of perivalvular leaks with Amplatzer occluders: feasibility, safety, and shortterm results. J Heart Valve Dis 2007;16:305-13.
  7. Reiss N, Schuett U, Maleszka A, Kleikamp G, Schenk S, Gummert J. Surgical removal of occluder devices: complications and pitfalls. Heart Surg Forum 2009;12:E143-6. https://doi.org/10.1532/HSF98.20091041