What is the likely cause for recurrent decompensated heart failure in this patient? The patient is a man in his 70s who underwent operative redo mitral valve replacement with a 25-mm Magna Ease bioprosthesis, followed by transcatheter implantation of 5 transcatheter Amplatzer Vascular Plugs (Abbott Cardiovascular) for the treatment of severe paravalvular leak (PVL). He presented with acute decompensated heart failure due to recurrent severe mitral PVL (Figure, A). PVL occurs in 5% to 15% of cases following surgical mitral valve replacement.1 Management options include repeated surgical intervention or transcatheter PVL closure.2 Transesophageal echocardiography including 3-dimensional reconstruction is critical in procedural planning and execution. The patient was a high-risk surgical candidate and underwent transcatheter PVL closure using 2 further Amplatzer Vascular Plugs (Figure, B) with reduction to mild PVL. Pressure tracings revealed reduction in left atrial pressures and amplitude of c-v waves.
Patel B, Sharkawi MA, Shah PB. Recurrent Paravalvular Leak Following Mitral Valve Replacement. JAMA Cardiol. 2021;6(12):e213737. doi:10.1001/jamacardio.2021.3737
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