Paravalvular leak closure

Updated on May 20, 2019


Definition and aetiology

Paravalvular leaks (PVLs) are defined as leakages around a previously implanted prosthesis due to an incomplete apposition of the sewing ring to the native tissue 11. Kim MS, Casserly IP, Garcia JA, Klein AJ, Salcedo EE, Carroll JD. Percutaneous transcatheter closure of prosthetic mitral paravalvular leaks: are we there yet?. JACC Cardiovasc Interv. 2009;2:81-90. Link. This problem is generally the consequence of suture dehiscence, and it is related to different anatomical and technical factors 22. Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003;89:1316-21. Link

FOCUS BOX 1Anatomical and technical factors related to paravalvular leaks

Anatomical factors
Annular calcium Friability of the annulus tissue Oval configuration of the native annulus (with circular shape of the prosthesis) Localised infection Lack of space of the valve sutures

Technical factors
Continuous sutures in mitral position Supra-annular implants in aortic position Difficulties in accessing the ring valve tissue Insufficient apposition of the prosthesis (in cases of TAVI)

PVLs after surgical valve replacement (SVR) are frequent, with an estimated incidence of 6% for aortic...

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