Paravalvular Leak Closure

Overview

What is a paravalvular leak?

This is a leak caused by a space between the patient’s natural heart tissue and the valve replacement.

  • It occurs in a small number of patients who have had a valve replacement (mechanical or bioprosthetic).
  • It most commonly affects the mitral valve, but it can also occur in the aortic and tricuspid valves.

How is paravalvular leak diagnosed?

The doctor may suspect a paravalvular leak if the patient has had a heart valve replacement and has symptoms of heart failure. These symptoms include shortness of breath, unexplained weight gain and swelling in their legs and feet (especially if they have the risk factors listed above). Sometimes small paravalvular leaks don’t cause heart failure symptoms. They may cause a special type of anemia called hemolytic anemia. The destruction of the red blood cells going through the hole between the artificial valve and the surrounding tissue may cause severe anemia that requires treatment with frequent blood transfusions.

Echocardiography (echo) is used to diagnose a paravalvular leak. Special types of echo, such as transesophageal echo (TEE) or 2-D or 3-D echo may be needed to confirm the diagnosis and determine the best treatment.

What treatment is used for patients with paravalvular leak?

This type of leak was traditionally repaired by returning to the operating room for a repeat heart surgery. Today, however, interventional cardiologists can use nonsurgical catheter-based treatment techniques to correct these leaks.

Closure of a paravalvular leak

Most often, the doctor will insert a catheter in the femoral vein in the groin (leg). A wire is guided through the catheter to the upper left chamber of the heart (left atrium), using a technique to go through the septum (muscular wall that divides the upper chambers of the heart into the right and left sides). A special catheter is used to place a closure device around the leak. The closure device basically acts like a plug to stop the leak.

In most cases, the procedure is done using a combination of local anesthetic and conscious sedation. It is not common to use general anesthesia, so the patient does not need a breathing tube. At Cleveland Clinic, this procedure is done in a catheterization lab.

If a patient has 2 mechanical valves in place, the doctor may use an apical approach rather than going through the femoral artery. An apical approach involves placing the catheter into the left side of the heart, through the chest wall, without making an incision. At Cleveland Clinic, this procedure is done in a special hybrid procedure room.

Safe and Effective

Interventional cardiologists at Cleveland Clinic have performed paravalvular procedures for many years. This procedure is an effective and less invasive treatment than surgery for patients with a paravalvular leak.

Risks / Benefits

Who is at risk for paravalvular leak?

Patients are at increased risk for paravalvular leak if:

  • They have had the same valve replaced multiple times
  • They are being treated for endocarditis
  • They have severe calcification of the valve annulus (the ring around the valve)

Resources

Doctors who treat

Cleveland Clinic has the nation's largest valve treatment program.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

Cleveland Clinic Heart, Vascular & Thoracic Institute Cardiologists and Surgeons

The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with Paravalvular Leak:

Department of Thoracic and Cardiovascular Surgery: When interventional procedures are not an option, surgeons in the Department of Thoracic and Cardiovascular Surgery are experts in the treatment of valve disease, including paravalvular leak closure and re-do valve operations.

Department of Cardiovascular Medicine: Non-surgical treatment of paravalvular leak is performed by interventional cardiologists from the Section of Invasive and Interventional Cardiology. A full evaluation is required to determine if you are a candidate for this procedure. For more information on how to be evaluated for non-surgical paravalvular leak closure, please contact our Heart, Vascular & Thoracic Institute Resource Nurses.

You may also use our MyConsult second opinion consultation using the Internet

See: About Us to learn more about the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute.

Contact

To obtain a surgical consultation, or if you have additional questions or need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Last reviewed by a Cleveland Clinic medical professional on 05/03/2019.

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