Korean Circ J.  2014 Jan;44(1):49-53. 10.4070/kcj.2014.44.1.49.

Transcatheter Closures for Fistula Tract and Paravalvular Leak after Mitral Valve Replacement and Tricuspid Annuloplasty

• Om SY
• Park GM
• Kim JY
• Yoon YH
• Lee S
• Kim YH
• Song JK

• KMID: 1859243
• DOI: http://doi.org/10.4070/kcj.2014.44.1.49

Abstract

Paravalvular leaks (PVLs) often occur after surgical valve replacement. Surgical reoperation has been the gold standard of therapy for PVLs, but it carries a higher operative risk and an increased incidence of re-leaks compared to the initial surgery. In high surgical risk patients with appropriate geometries, transcatheter closure of PVLs could be an alternative to redo-surgery. Here, we report a case of successful staged transcatheter closures of a fistula tract between the aorta and right atrium, and mitral PVLs after mitral valve replacement and tricuspid annuloplasty.

Keyword

Paravalvular leaks; Transcatheter closure; Mitral valve replacement

MeSH Terms

Aorta
Fistula*
Heart Atria
Humans
Incidence
Mitral Valve*
Reoperation
Surgical Instruments

Figure

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  Fig. 1 Transesophageal echocardiographic images showing shunt flow from the aorta to the right atrium. Shunt flow was evident on color Doppler flow mapping (A), and the diameter of the fistula (arrows) was 4 mm (B). Ao: aorta, LA: left atrium, RA: right atrium, RV: right ventricle.

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  Fig. 2 Transesophageal echocardiographic images showing paravalvular leakage. Pathologic paravalvular mitral regurgitation jet (arrow) was evident at the lateral mitral annulus on color Doppler flow mapping (A), and the defect size was 4 mm (B). LA: left atrium, LV: left ventricle.

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  Fig. 3 Computed tomographic images showing paravalular leakage. The maximal defect size was 3 mm (A) and reconstructed images for the cardiac surgeons from the left atrial side showed that the defect was located at the antero-lateral mitral annulus (arrow, B).

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  Fig. 4 Fluoroscopic images showing the procedure. A 6 Fr Cournand catheter was advanced into and passed through the defect from the aorta to the right atrium, and another 6 Fr Cournand catheter was introduced into the right atrium (A). An 8/6 mm sized Amplatzer duct occluder was deployed in the fistula tract from the aorta to the right atrium (B).

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  Fig. 5 Immediately after the procedure, both fluoroscopy (A) and transesophageal echocardiography (B) showed a well-positioned device and no remnant shunt (arrows).

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  Fig. 6 Fluoroscopic images of the second procedure. After septal puncture (A), an 8/6 mm sized Amplatzer duct occluder was deployed in the tissue defect in the mitral annulus (arrow) (B).

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  Fig. 7 Transesophageal echocardiographic images immediately after the procedure. Color Doppler flow mapping showed no remnant paravalvular leakage (A) and 3-dimensional echocardiography showed a well-positioned occluder (arrow) (B).

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