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.

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

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