Paravalvular leak closure

Overview

Paravalvular leak closure is a minimally invasive technique designed to address leaks around heart valves that may occur after a valve replacement. Interventional cardiologists use this method to repair these leaks without the need for additional surgery, which is particularly beneficial for patients with certain heart conditions where further surgery could be riskier. The procedure involves smaller incisions and generally results in a quicker recovery compared to traditional surgery.

While medication is often used to manage paravalvular leaks, it may not always be effective. In cases where medication fails and additional heart valve surgery is not an option, your healthcare provider might recommend PVL closure. This approach can effectively repair leaks around heart valves and relieve associated symptoms.

Reasons for undergoing the procedure

A leak closure may be beneficial if you have had numerous valve replacement procedures or if you:

• Are receiving treatment for endocarditis
• Experience moderate to severe backward flow of blood
• Have significant calcification (calcium deposits) on the valve ring (valve annulus)
• Suffer from shortness of breath (dyspnea)
• Have hemolytic anemia due to blood cell damage from the leakage

Not everyone is suitable for paravalvular leak closure. Your healthcare provider will help determine the most appropriate treatment options for your specific situation.

Risk

The risks of paravalvular leak closure include:

• Adverse reactions to anesthesia
• Allergic reactions to contrast dyes or medications
• Arrhythmias or changes in heart rhythm
• Bleeding
• Blood clots
• Damage to blood vessels or heart structures
• Device-related complications such as dislodgement or malfunction
• Infection at the insertion site

It’s important to discuss these risks with your healthcare provider to understand how they apply to your specific situation.

Before the procedure

Your healthcare provider will perform a comprehensive physical examination to assess your overall health and heart function. To rule out endocarditis, they may also order blood cultures, which involve taking multiple blood samples over a period of time.

To diagnose paravalvular leaks (PVL) and plan treatment, your healthcare provider may use various imaging tests, including:

• Electrocardiogram (EKG)
• Echocardiogram
• Transesophageal echocardiogram (TEE)
• Angiogram
• Cardiac CT scan
• Heart MRI

Typically, interventional cardiologists perform PVL procedures in a cardiac catheterization lab, which is usually located within a hospital or medical center.

Before the procedure, your healthcare provider will give you detailed instructions on when you can eat and drink, what to wear on the day of your treatment, and which medications you may need to stop or adjust.

It’s also important to inform your provider about any allergies you have and any supplements or medications you’re taking, including blood thinners (anticoagulants) or nonsteroidal anti-inflammatory drugs (NSAIDs).

During the procedure

Before the procedure begins, you’ll typically receive local anesthesia and medication to ensure you don’t feel any pain. Your cardiologist will use advanced imaging techniques to:

• Insert a thin, catheter (hollow tube) into the femoral artery in your groin (upper thigh)
• Guide a wire through the catheter to the correct chamber of your heart
• Deploy a closure device to seal the leak using a specialized catheter
• Remove the catheters out of the blood vessel.

If you have two synthetic (artificial) valves, your interventional cardiologist may insert the catheter into the side of the heart. Unlike traditional surgery, this approach does not require an incision on your chest.

Most paravalvular leak closures last between two and three hours, and over time, your heart tissue will grow around the device, integrating it into your heart’s normal function.

After the procedure

After the procedure, you will typically stay overnight for observation and leave the following morning. Your healthcare provider will give you guidance on when it is safe to resume your regular activities and provide detailed care instructions to support your recovery.

About three months after the treatment, your cardiologist will conduct follow-up testing to ensure the valve is functioning correctly and to check for any leaks.

Outcome

When compared to conventional (open) surgery, paravalvular leak closure has the following advantages:

• Shorter recovery time
• Reduced risk of infection
• Shorter hospital stay
• Smaller incisions and scars

Observe the recommendations of your healthcare provider and show up for all scheduled checkups. If you have any concerning symptoms, such as an unexplained fever, soreness, or swelling in your groin area, get in touch with your healthcare provider.

After your PVL closure treatment, you will usually have a follow-up appointment three months later.