Detachment of the Amplatzer Device after Interventional Closure of a Mitral Prosthesis Paravalvular Leak
Background: Paraprosthetic leak is a complication of mitral and aortic valve implantation interventions, that can be treated either through a surgical procedure (repair or replacement of the prosthesis) or by means of a less-invasive percutaneous transcatheter approach. Nevertheless, this percutaneous intervention carries complications on its own, one of them being displacement of the occluder device.
Results: This is the case of a 66-year-old patient, with a clinical history of two mitral valve replacement procedures, who presented with dyspnea, fatigue, and peripheral edema. Echocardiographic findings described severe mitral regurgitation due to the presence of a paravalvular leak. Considering the high perioperative mortality, renal and respiratory impairment, and the fact that this reoperation would have been the third cardiac surgery for the patient, percutaneous transcatheter closure of the leak was recommended. Four days after the successful procedure, a checkup echocardiogram revealed the migration of the occluder device to the left atrial cavity. Even though the operative risk was high and the prognosis poor, the only available treatment option was the surgical management that achieved the removal of the device and replacement of the diseased prosthesis.
Conclusion: In conclusion, albeit a less invasive approach, with lower risks and better outcomes, the percutaneous intervention for leak closure has some clinically relevant complications that must be addressed promptly. One of these complications – detachment of the occluder device – even if quite rare, is a significant event that requires immediate surgical or interventional approach. A careful postoperative checkup is therefore essential to detect any complication and to address it directly.
2. Smolka G, Wojakowski W. Paravalvular leak - important complication after implantation of prosthetic valve. E-Journal of the ESC Council for Cardiology Practice. 2010; 9(8).
3. Branny M, Januška J, Škňouřil L, Holek B, Dorda M, Gajdůšek L. Management of paravalvular leaks. Cor et Vasa. 2012; 54(3): e151-e5.
4. Yuan SM, Shinfeld A, Raanani E. Displacement of the Amplatzer occluder device from the mitral paraprosthetic leak. Interactive cardiovascular and thoracic surgery. 2008; 7(6): 1131-3. eng
5. Eleid MF, Cabalka AK, Malouf JF, Sanon S, Hagler DJ, Rihal CS. Techniques and Outcomes for the Treatment of Paravalvular Leak. Circ Cardiovasc Interv. 2015; 8(8): e001945.
6. Gafoor S, Franke J, Bertog S, Lam S, Vaskelyte L, Hofmann I, et al. A Quick Guide To Paravalvular Leak Closure. Interventional Cardiology Review. 2015; 10(2).
7. Eeckhout E, Carlier S, Lerman A, Kern M. Handbook of Complications during Percutaneous Cardiovascular Interventions. United Kingdom: Informa Healthcare; Informa UK Ltd; 2007. 270-272 p.
8. Ussia GP, Scandura S, Calafiore AM, Mangiafico S, Meduri R, Galassi AR, et al. Images in cardiovascular medicine. Late device dislodgement after percutaneous closure of mitral prosthesis paravalvular leak with Amplatzer muscular ventricular septal defect occluder. Circulation. 2007; 115(8): e208-10.
9. Godinho AR, Almeida PB, Sousa C, Goncalves A, Silva JC, Maciel MJ. Late device embolization in a persistent mitral paravalvular leak. Rev Port Cardiol. 2015; 34(4): 291 e1-4.
10. Arzamendi D, Li CH, Serra A. Late embolization of a vascular plug III device after mitral paravalvular leak closure. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions. 2013; 82(6): E831-4.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to email@example.com
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to firstname.lastname@example.org