Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:141-146
Transcatheter Closure of a Mitral Valve Paravalvular Leak in an Infant
Department of Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
Mitral valve replacement, which is a relatively rare procedure in young children, can be complicated by paravalvular leaks (PVLs). Here, we report the first successful percutaneous treatment of a PVL in an infant. The patient was a 7-month-old, 6 kg boy with a history of Shone’s complex after aortic arch reconstruction and balloon valvuloplasty of the mitral valve. Due to severe mitral insufficiency, he underwent mitral valve replacement with a 16-mm Medtronic open-pivot AP 360 mechanical aortic valve in the supra-annular mitral position at 5 months of age. He developed a posterior PVL post-operatively with persistent hemolysis requiring repeated transfusions. Medical therapy with pentoxifylline failed. Thus, 2 months post-operatively, he was referred for percutaneous cardiac catheterization for PVL closure. Transesophageal echocardiography (TEE) identified a small PVL between the mouth of the left atrial appendage and the left upper pulmonary vein. A trans-septal approach was utilized. Using a Cobra catheter, a 0.018” floppy wire was advanced from the venous sheath through the leak and into the ascending aorta, where it was snared by a multisnare introduced from the arterial sheath. A 4-mm Amplatzer vascular plug II was then positioned anterogradely and successfully deployed in the tract. No significant leak was visualized by angiography or TEE, and the child’s hemolysis subsided. Our case demonstrates that device closure of mitral valve PVL in a very small child is technically feasible and may obviate repeat surgery.
Cite this article as: Nwankwo U, Goldsmith J, Trucco S, Kreutzer J. Transcatheter Closure of a Mitral Valve Paravalvular Leak in an Infant. Structural Heart Disease 2017;3(5):141-146. DOI: 10.12945/j.jshd.2017.019.17
You must be registered and logged in to leave comments.
There have been no comments posted yet
All comments will be screened and reviewed before posting. Statements, opinions, and results of studies published in Journal of Structural Heart Disease are those of the authors and do not reflect the policy or position of The Journal and Science International and the Editorial Board and provides no warranty as to their accuracy or reliability. Material is copyrighted and owned by Science International and cannot be used without expressed permission.