A case of perivalvular leakage and attempt of closure operation after transcatheter aortic valve replacement_West China Medical Journal

Authors：

SU Wen , HUANG Yiyuan , TAI Shi , TANG Jianjun ,  FANG Zhenfei

Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha 410000, P. R. China;

Corresponding author：

FANG Zhenfei, Email: fangzhenfei@csu.edu.cn

Keywords：

Transcatheter aortic valve replacement; Paravalvular leak closure; Aortic valve calcification

DOI：

10.7507/1002-0179.202002386

Video：

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This paper reported a 75-year-old female patient. She was admitted to our hospital for “repeated chest pain, shortness of breath for more than 5 years, and syncope 3 times”. The CT scan of the patient showed severe aortic valve stenosis, bicuspid valve, and severe calcification; then she underwent transcatheter aortic valve replacement in our hospital. After the prosthesis was implanted, there was a significant paravalvular leak. Considering the triangular area formed between the calcified clumps, the valve was not fully dilated. Paravalvular leak closure was performed during the operation, attempted through the valve stent mesh to closuring. A rare incarceration of the transmitter occurred. An attempt was made to pull out the incarcerated transmitter through a pull-up technique, which resulted in the prosthesis prolapse. The patient was eventually transferred to surgery aortic valve replacement.

Citation： SU Wen, HUANG Yiyuan, TAI Shi, TANG Jianjun, FANG Zhenfei. A case of perivalvular leakage and attempt of closure operation after transcatheter aortic valve replacement. West China Medical Journal, 2020, 35(4): 484-488. doi: 10.7507/1002-0179.202002386 Copy

1.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
2.	中华医学会心血管病学分会结构性心脏病学组, 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识. 中国循环杂志, 2018, 33(12): 1162-1169.
3.	Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation, 2013, 127(3): 397-407.
4.	Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3, 519 patients from 16 studies. J Am Coll Cardiol, 2012, 59(25): 2317-2326.
5.	Larroche J, Panh L, Lhermusier T, et al. Impact of aortic valve calcification severity on device success after transcatheter aortic valve replacement. Int J Cardiovasc Imaging, 2020, 36(4): 731-740.
6.	Pollari F, Dell’Aquila AM, Söhn C, et al. Risk factors for paravalvular leak after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2019, 157(4): 1406-1415.e3.
7.	Pavicevic J, Nguyen TD, Caliskan E, et al. Aortic valve calcium score is a significant predictor for the occurrence of post-interventional paravalvular leakage after transcatheter aortic valve implantation - results from a single center analysis of 260 consecutive patients. Int J Cardiol, 2015, 181: 185-187.
8.	Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
9.	Yoon SH, Bleiziffer S, De Backer O, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol, 2017, 69(21): 2579-2589.
10.	Gafoor S, Franke J, Piayda K, et al. Paravalvular leak closure after transcatheter aortic valve replacement with a self-expanding prosthesis. Catheter Cardiovasc Interv, 2014, 84(1): 147-154.
11.	Dhoble A, Chakravarty T, Nakamura M, et al. Outcome of paravalvular leak repair after transcatheter aortic valve replacement with a balloon-expandable prosthesis. Catheter Cardiovasc Interv, 2017, 89(3): 462-468.
12.	Meredith Am IT, Walters DL, Dumonteil N, et al. Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE Ⅱ study. J Am Coll Cardiol, 2014, 64(13): 1339-1348.
13.	Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
14.	Gilard M, Eltchaninoff H, Iung B, et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med, 2012, 366(18): 1705-1715.
15.	Van Belle E, Juthier F, Susen S, et al. Postprocedural aortic regurgitation in balloon-expandable and selfexpandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry. Circulation, 2014, 129(13): 1415-1427.
16.	Waterbury TM, Reeder GS, Pislaru SV, et al. Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2017, 90(5): 870-877.
17.	Ruiz CE, Hahn RT, Berrebi A, et al. Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis: an expert statement. J Am Coll Cardiol, 2017, 69(16): 2067-2087.
18.	Eleid M. Interventional management of paravalvular leak. Heart, 2018, 104(21): 1797-1802.
19.	Kim MS, Casserly IP, Garcia JA, et al. Percutaneous transcatheter closure of prosthetic mitral paravalvular leaks: are we there yet?. JACC Cardiovasc Interv, 2009, 2(2): 81-90.
20.	Goktekin O, Vatankulu MA, Ozhan H, et al. Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder. EuroIntervention, 2016, 11(10): 1195-1200.
21.	Eleid MF, Cabalka AK, Malouf JF, et al. Techniques and outcomes for the treatment of paravalvular leak. Circ Cardiovasc Interv, 2015, 8(8): e001945.
22.	Koo HJ, Lee JY, Kim GH, et al. Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features. Eur Heart J Cardiovasc Imaging, 2018, 19(12): 1419-1427.
23.	Bernard S, Yucel E. Paravalvular leaks-from diagnosis to management. Curr Treat Options Cardiovasc Med, 2019, 21(11): 67.

1. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
2. 中华医学会心血管病学分会结构性心脏病学组, 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识. 中国循环杂志, 2018, 33(12): 1162-1169.
3. Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation, 2013, 127(3): 397-407.
4. Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3, 519 patients from 16 studies. J Am Coll Cardiol, 2012, 59(25): 2317-2326.
5. Larroche J, Panh L, Lhermusier T, et al. Impact of aortic valve calcification severity on device success after transcatheter aortic valve replacement. Int J Cardiovasc Imaging, 2020, 36(4): 731-740.
6. Pollari F, Dell’Aquila AM, Söhn C, et al. Risk factors for paravalvular leak after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg, 2019, 157(4): 1406-1415.e3.
7. Pavicevic J, Nguyen TD, Caliskan E, et al. Aortic valve calcium score is a significant predictor for the occurrence of post-interventional paravalvular leakage after transcatheter aortic valve implantation - results from a single center analysis of 260 consecutive patients. Int J Cardiol, 2015, 181: 185-187.
8. Mylotte D, Lefevre T, Søndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
9. Yoon SH, Bleiziffer S, De Backer O, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol, 2017, 69(21): 2579-2589.
10. Gafoor S, Franke J, Piayda K, et al. Paravalvular leak closure after transcatheter aortic valve replacement with a self-expanding prosthesis. Catheter Cardiovasc Interv, 2014, 84(1): 147-154.
11. Dhoble A, Chakravarty T, Nakamura M, et al. Outcome of paravalvular leak repair after transcatheter aortic valve replacement with a balloon-expandable prosthesis. Catheter Cardiovasc Interv, 2017, 89(3): 462-468.
12. Meredith Am IT, Walters DL, Dumonteil N, et al. Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE Ⅱ study. J Am Coll Cardiol, 2014, 64(13): 1339-1348.
13. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
14. Gilard M, Eltchaninoff H, Iung B, et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med, 2012, 366(18): 1705-1715.
15. Van Belle E, Juthier F, Susen S, et al. Postprocedural aortic regurgitation in balloon-expandable and selfexpandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry. Circulation, 2014, 129(13): 1415-1427.
16. Waterbury TM, Reeder GS, Pislaru SV, et al. Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2017, 90(5): 870-877.
17. Ruiz CE, Hahn RT, Berrebi A, et al. Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis: an expert statement. J Am Coll Cardiol, 2017, 69(16): 2067-2087.
18. Eleid M. Interventional management of paravalvular leak. Heart, 2018, 104(21): 1797-1802.
19. Kim MS, Casserly IP, Garcia JA, et al. Percutaneous transcatheter closure of prosthetic mitral paravalvular leaks: are we there yet?. JACC Cardiovasc Interv, 2009, 2(2): 81-90.
20. Goktekin O, Vatankulu MA, Ozhan H, et al. Early experience of percutaneous paravalvular leak closure using a novel Occlutech occluder. EuroIntervention, 2016, 11(10): 1195-1200.
21. Eleid MF, Cabalka AK, Malouf JF, et al. Techniques and outcomes for the treatment of paravalvular leak. Circ Cardiovasc Interv, 2015, 8(8): e001945.
22. Koo HJ, Lee JY, Kim GH, et al. Paravalvular leakage in patients with prosthetic heart valves: cardiac computed tomography findings and clinical features. Eur Heart J Cardiovasc Imaging, 2018, 19(12): 1419-1427.
23. Bernard S, Yucel E. Paravalvular leaks-from diagnosis to management. Curr Treat Options Cardiovasc Med, 2019, 21(11): 67.

West China Medical Journal

A case of perivalvular leakage and attempt of closure operation after transcatheter aortic valve replacement

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