Page 34 - Journal of Structural Heart Disease Volume 5, Issue 1

23 Case Report
Figure 2. Panel A. Arteriogram showing the PVL (arrow head) after balloon occlusion (arrow) of the pulmonary bioprosthetic valve; Panel B. PVL size confirmed using Armada balloon (8x4mm) passed across the leak; Panel C. 12mm AVP II successfully deployed in the tunnel-like leak.
Discussion
The standard treatment for pulmonary PVL is sur- gical intervention with valve replacement and repair [3]. However, surgery is associated with a higher risk for morbidity and mortality than primary repair or valve replacement. In a study of 122 patients with PVL (mitral=67.2%, and aortic=32.8%), the 12-year survival following surgery was about 30%–40% with high rates of recurrence [4]. Transcatheter interven- tion in the setting of bioprosthetic mitral and aortic valve PVL has been shown to have better long-term outcomes than surgery [5]. The AVP II is the most common device used for mitral and aortic valve PVL due to the shape of its discs resulting in good epithe- lization and providing an optimal seal. Other off-label devices that may be used for PVL closure by physician discretion and expertise are ventricular septal defect, atrial septal defect, and patent ductus arteriosus oc- cluders, AVP I, and AVP III [1]. However, no dedicated catheters or devices are currently approved for PVL closure by the U.S. Food and Drug Administration.
Although transcatheter closure of pulmonary PVL are previously reported using the AVP II and ventric-
ular septal defect occluders [2, 3], it is associated with risks including impingement of valve leaflets, device embolization, hemolysis, pericardial effusion, and arrhythmias [1]. Successful transcatheter pulmonary PVL closure is dependent on appropriate case selec- tion and operator expertise. The alternative to device occlusion is to use a covered stent in anatomically appropriate conduit with placement of transcatheter valve in the stent.
Pulmonary PVL following bioprosthetic valve im- plantation is rare, but can be a hemodynamically sig- nificant complication. Transcatheter intervention is a feasible treatment option with lower complication rates than surgery and must be considered in the set- ting of pulmonary PVL.
Conflict of Interest
The authors have no conflict of interest relevant to this publication.
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Kaley V. R. et al.
Transcatheter Intervention for PVL