Publish in this journal
Journal Information
Vol. 65. Issue 3.
Pages 287 (March 2012)
DOI: 10.1016/j.rec.2010.05.006
Full text access
Failed Percutaneous Closure of a Mitral Prosthesis Paravalvular Leak
Cierre percutáneo fallido de fuga periprotésica mitral
Manuel Carnero Alcázara,
Corresponding author

Corresponding author:
, Luis Carlos Maroto Castellanosa, José Enrique Rodríguez Hernándeza
a Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
This item has received
(Daily data update)
Article information
Full Text
Download PDF
Figures (3)
Show moreShow less
Full Text

A 77-year-old man who had a mechanical prosthetic mitral valve and aortic valve implanted in 1993 presented dyspnea and anemia, and was diagnosed of mitral prosthesis paravalvular leak. The patient was considered at high operative risk owing to his age, severe pulmonary hypertension, chronic renal failure, and previous cardiac surgery. Surgical treatment in his reference hospital was therefore excluded, and he was referred to the cardiology service of our hospital to evaluate percutaneous closure.

Echocardiography in 3D mode showed severe prosthetic paravalvular mitral regurgitation (Figure 1, arrows). Three Amplatzer devices for percutaneous closure were implanted (Figure 2, asterisks), which reduced the regurgitation to a moderate grade (Figure 2, arrows). Two months later, the patient was readmitted for heart failure and hemolytic anemia. A new case of severe regurgitation had occurred due to an increase in the residual paravalvular leaks following percutaneous closure. The patient's clinical status progressively deteriorated (pulmonary edema, low cardiac output, anuria), and emergency surgery was decided to remove the percutaneous devices (Figure 3, arrows) and replace the mitral prosthesis. Although the immediate postoperative period was uneventful (normal function of the prosthesis on transesophageal echocardiography), the patient died on the eighth day due to acute intestinal ischemia.

Figure 1.

Figure 2.

Figure 3.

The treatment of choice for paravalvular leak of a cardiac valve prosthesis is surgical replacement of the prosthesis. Percutaneous closure is not free from associated morbidity and mortality, and the results are often suboptimal. Thus, this option should only be contemplated in patients with a prohibitive surgical risk, as determined by joint assessment on the part of surgeons and cardiologists.

Corresponding author:

Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.