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      EchoNavigator virtual marker and Agilis NxT steerable introducer facilitate transseptal transcatheter closure of mitral paravalvular leak

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          Abstract

          BACKGROUND

          Paravalvular leak (PVL), also known as paravalvular prosthetic regurgitation, is not a rare complication after surgical valve replacement, and it may cause varying degrees of heart failure. The transcatheter closure of PVL is technically demanding and challenging.

          CASE SUMMARY

          A 68-year-old man presented with degenerative mitral regurgitation with heart failure, New York Heart Association functional class 3. He received bioprosthetic mitral valve replacement in December 2019. PVL was noted at the location of the aorto-mitral curtain in transesophageal echocardiography without signs of endocarditis or dehiscence of the bioprosthetic valve. Transseptal transcatheter closure of the mitral PVL was performed efficiently using the EchoNavigator virtual marker and Agilis NxT steerable introducer.

          CONCLUSION

          This case highlights that the EchoNavigator virtual marker and Agilis NxT steerable introducer can facilitate transseptal transcatheter closure of mitral PVL by reducing the procedure time and contrast media.

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          Most cited references7

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          Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks.

          The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia. Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgical repair of this defect in high-risk surgical patients. This is a retrospective review of 57 percutaneous paravalvular leak closures that were performed in 43 patients (67% male, mean age 69.4 ± 11.7 years) between April 2006 and September 2010. Integrated imaging modalities were used for the evaluation, planning, and guidance of the interventions. Closure was successful in 86% of leaks and in 86% of patients. Twenty-eight of 35 patients improved by at least 1 New York Heart Association functional class. The percentage of patients requiring blood transfusions and/or erythropoietin injections post-procedure decreased from 56% to 5%. Clinical success was achieved in 89% of the patients in whom procedure was successful. The survival rates for patients at 6, 12, and 18 months after paravalvular leak closures were 91.9%, 89.2%, and 86.5%, respectively. Freedom from cardiac-related death at 42 months post-procedure was 91.9%. Percutaneous closure of symptomatic paravalvular leaks, facilitated by integrated imaging modalities has a high rate of acute and long-term success and appears to be effective in managing symptoms of heart failure and hemolytic anemia. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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            Techniques and Outcomes for the Treatment of Paravalvular Leak

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              Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up.

              To assess the incidence and natural course of paravalvular leaks detected early after aortic valve replacement. Although the use of echocardiography has simplified the postoperative assessment of patients with aortic valve replacement, there are no data regarding the natural history of early detected paravalvular aortic leaks. Eighty-four consecutive patients with aortic valve replacement were prospectively followed clinically every 6 months and by echocardiography early (11 +/- 7 days), at midterm (27 +/- 3 months), and late (63 +/- 4 months) after aortic valve replacement. The competence of artificial valves was assessed by Doppler color flow mapping. Paraprosthetic leaks were detected in 40 (47.6%) aortic prostheses during the early study; the majority (90%) were small. All leaks remained unchanged during the follow-up period. Left ventricular dimensions and function did not differ between patients with or without paravalvular leak during the follow-up. Left ventricular fractional shortening, however, increased during the intermediate study in both subgroups, indicating improved left ventricular function overall. Three patients had severe paravalvular regurgitation suddenly develop from late infective endocarditis, and 1 patient had a degenerative tissue valve failure 4 years after implantation. Paraprosthetic aortic leaks detected early after surgery, in the absence of valve infection, are common, are usually small, and have a benign course. However, the development of new, usually severe, regurgitation should raise the suspicion of prosthetic valve endocarditis or bioprosthetic valve failure.
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                Author and article information

                Contributors
                Journal
                World J Clin Cases
                WJCC
                World Journal of Clinical Cases
                Baishideng Publishing Group Inc
                2307-8960
                6 May 2022
                6 May 2022
                : 10
                : 13
                : 4236-4241
                Affiliations
                Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
                General Education Center, Lunghwa University of Science and Technology, Taoyuan City 333026, Taiwan. jungchenghsu@ 123456gmail.com
                Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
                Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
                Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
                Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
                Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
                Author notes

                Author contributions: Hsu JC and Wu YW were the patient’s cardiologists, reviewed the literature and contributed to manuscript drafting; Khoi CS was the interventional echocardiographer who performed the transesophageal echocardiography during the procedure, and contributed to illustrations and manuscript drafting; Huang SH and Chang YY were also cardiologists who performed the follow-up transthoracic echocardiography for the patient and contributed to manuscript drafting. Cheng SL provided technical assistance during the procedure and contributed to the literature review; all authors issued final approval for the version to be submitted. No competing interests were disclosed by any author.

                Corresponding author: Jung-Cheng Hsu, MD, Attending Doctor, Division of Cardiology, Department of Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City 220216, Taiwan. jungchenghsu@ 123456gmail.com

                Article
                jWJCC.v10.i13.pg4236
                10.12998/wjcc.v10.i13.4236
                9131240
                0d2c98ef-53b1-4a52-86a3-7047b1f7fb02
                ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 5 October 2021
                : 20 January 2022
                : 16 March 2022
                Categories
                Case Report

                paravalvular leak,paravalvular prosthetic regurgitation,echonavigator,steerable introducer,case report

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