Paravalvular Leak Closure

Overview

What is paravalvular leak closure?

Paravalvular leak (PVL) closure is a nonsurgical treatment to repair heart valve leaks that occur after valve replacement. Interventional cardiologists use the treatment to repair leaks instead of performing additional surgery. Repeat surgery can pose a higher risk to some people with heart disease.

Paravalvular leaks are often treated with medication. But when drugs don’t work, and heart valve surgery isn’t an option, your provider may recommend PVL closure. This minimally invasive treatment can repair leaks around heart valves and improve symptoms.

When is this procedure performed?

You may benefit from a leak closure if you’ve had multiple surgeries to replace a valve or if you:

  • Are being treated for endocarditis.
  • Experience moderately severe or severe backward flow of blood.
  • Have severe calcification (calcium deposits) on the ring around the valve (valve annulus).
  • Have shortness of breath (dyspnea).
  • Have shearing of your blood cells from the leakage (hemolytic anemia).

Not everyone is a good candidate for paravalvular leak closure. Your healthcare provider can discuss the most appropriate treatment options for your needs.

Procedure Details

What happens before paravalvular leak closure?

Your healthcare provider does a complete physical examination to assess your health and heart function. Your provider may also use blood cultures (blood tests taken over time) to rule out endocarditis.

Your provider may use imaging tests to diagnose PVL and determine treatment. These tests may include:

Who performs paravalvular leak closure?

An interventional cardiologist performs paravalvular leak closure. Your cardiologist works with heart imaging specialists during the procedure.

Where is a paravalvular leak closure performed?

Interventional cardiologists typically perform PVL in a cardiac catheterization lab. This type of lab is usually in a hospital or medical center.

How should I prepare for paravalvular leak closure?

Your healthcare provider gives you instructions before the procedure, including:

  • When you can eat and drink.
  • What to wear on the day of your treatment.
  • What medications to stop taking or adjust.

Before your procedure, tell your healthcare provider about:

What happens during paravalvular leak closure?

You typically receive local anesthesia and medication before the procedure begins, so you don’t feel any pain. Using advanced imaging techniques, your cardiologist:

  • Inserts a thin, hollow tube (catheter) into the femoral artery in your groin (upper thigh).
  • Guides a wire through the catheter to the appropriate chamber of your heart.
  • Places a closure device to plug the leak using a special catheter.
  • Removes the catheters from your blood vessel.

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

How long does a paravalvular leak closure take?

Most paravalvular leak closures take two to three hours. Your heart tissue grows around the device over time, and the device becomes part of your heart’s normal functioning.

What happens after paravalvular leak closure?

Typically, you stay overnight for observation after the procedure and leave the following morning. Your healthcare provider gives you specific care instructions to help you recover. Ask your provider about when you can safely return to your regular activities.

Your cardiologist performs follow-up tests to check for leaks and proper valve function. This typically occurs about three months after your procedure.

Risks / Benefits

What are the advantages of paravalvular leak closure?

The benefits of paravalvular leak closure compared to traditional (open) surgery include:

  • Less recovery time.
  • Lower risk of infection.
  • Shorter hospital stay.
  • Smaller incisions and scars.

When to Call the Doctor

When should I see my healthcare provider?

Follow your healthcare provider’s instructions and keep your medical appointments. Contact your provider if you have unexplained fever, pain, swelling around your groin area or other symptoms. In most cases, you see your provider three months after your PVL closure procedure.

A note from Cleveland Clinic

It’s important to go for regular checkups if you’ve had a heart valve replacement. Sometimes, your new valve can develop leaks. Treatment may include medication, repeat surgery or paravalvular leak closure. Talk to your healthcare provider about the best option to suit your needs.

Last reviewed by a Cleveland Clinic medical professional on 08/31/2022.

References

  • American College of Cardiology. Transcatheter Management of Paravalvular Leaks. (https://www.acc.org/latest-in-cardiology/articles/2017/02/02/08/25/transcatheter-management-of-paravalvular-leaks) Accessed 8/31/2022.
  • Cruz-Gonzalez I, Rama-Merchan JC, Rodríguez-Collado J, et al. Transcatheter closure of paravalvular leaks: state of the art. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260617/) Neth Heart J. 2017;25(2):116-124. Accessed 8/31/2022.
  • Calvert PA, Northridge DB, Malik IS, et al. Percutaneous Device Closure of Paravalvular Leak: Combined Experience From the United Kingdom and Ireland. (https://pubmed.ncbi.nlm.nih.gov/27587432/) Circulation. 2016;134(13):934–944. Accessed 8/31/2022.

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