Paravalvular Leak Closure

A paravalvular leak is caused by space between the patient’s natural heart tissue and the valve replacement. It occurs in a small number of patients who have had a valve replacement. The following may put you at risk for paravalvular leaks:

• Having the same valve replaced multiple times
• Being treated for endocarditis
• Severe calcification of the valve annulus (the ring around the valve)

A doctor may suspect a paravalvular leak if the patient has had a heart valve replacement and has symptoms of heart failure. Symptoms of heart failure may include:

• Shortness of breath
• Unexplained weight gain and swelling in legs and feet

Sometimes small paravalvular leaks don’t cause heart failure symptoms. They may cause a special type of anemia called hemolytic anemia. The destruction of red blood cells going through the hole and between the artificial valve may cause severe anemia that requires frequent blood transfusions. Echocardiography is used to diagnose a paravalvular leak.

Traditionally, a paravalvular leak was treated with heart surgery. However, interventional cardiologists can now use non-surgical catheter-based treatment techniques to correct these leaks.

Closure of a paravalvular leak requires a doctor to insert a catheter in the femoral vein in the groin (leg). A wire is guided through the catheter to the upper left chamber of the heart (left atrium) using a technique going through the septum (the muscular wall that divides the upper chambers of the heart into the left and right side). A special catheter is used to place a closure device around the leak. This device acts like a plug to stop the leak.

In most cases, anesthesia is not used and the patient does not need a breathing tube. Instead, the procedure is done using a combination of local anesthetic and conscious sedation.