We present the case of a 52-year-old patient with lupus and chronic leishmaniosis diagnosed with symptomatic mitral regurgitation at another center. The patient was referred to evaluate percutaneous edge-to-edge mitral valve repair in our center due to comorbidities. Transesophageal echocardiography showed normal function of the mitral valve and the presence of a left ventricle to left atrium shunt located next to the antero-lateral annulus (figure 1, videos 1-3 of the supplementary data). This generated an eccentric jet that swept along the mitral coaptation line mimicking severe mitral regurgitation in transthoracic echocardiography (video 4 of the supplementary data). The etiology of the shunt was not clear, but we hypothesized that it could be secondary to a previous drained paravalvular abscess since the patient had a long history of immunosuppressive treatment and several episodes of fever in the setting of chronic leishmaniosis.

Figure 1

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The patient was presented at a heart team session, and it was decided to treat the shunt percutaneously with a plug. The intervention (figure 2) was conducted following the steps of a paravalvular prosthetic mitral paravalvular leak closure. Echo-guided transseptal access was performed to introduce a deflectable catheter in the left atrium, which was guided toward the atrial orifice of the fistula (figure 1, arrows) to cross the defect (video 5 of the supplementary data). After 3-dimensional echo measurements, an Amplatzer Vascular Plug III 14 x 5 mm (Abbott, United States) (figure 2 and figure 3, arrows) was successfully implanted with a mild-to-moderate residual shunt across the device (video 6 of the supplementary data). The 3-month follow-up transesophageal echocardiography (figure 3, videos 7, 8 of the supplementary data) showed significant improvement with only minimal residual shunt. Informed consent was obtained by telephone.

Figure 2

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Figure 3

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