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• W4224011670 abstract "We report the case of a 58-year-old patient with history of mechanical mitral valve replacement 1 year ago due to Staphylococcus aureus endocarditis that resulted in severe mitral regurgitation. During follow-up, he had progressive heart failure symptoms, New York Heart Association class III, with severe hemolytic anemia. Transthoracic echocardiography revealed mildly dilated left ventricle and dilated left atrium with evidence of severe mitral paravalvular leak (PVL) and severe aortic regurgitation (AR). Transesophageal echocardiography (TEE) showed severe anterolateral mitral PVL (Figure 1) and severe AR due to perforation of the noncoronary cusp (NCC; Supplemental Video 1). After refusing surgery, we decided to perform transcatheter mitral PVL device closure and to assess the AR perforation for possible intervention. Under general anesthesia and TEE guidance, the mitral valve PVL was managed through a trans-septal approach. After crossing the leak with the aid of an Agilis Medium deflectable catheter, an 8F Cook shuttle sheath was advanced across the mitral PVL, and an AMPLATZER Vascular Plug (AVP) III 10/5 mm was deployed successfully with the resolution of the leak and significant decrease of the left atrial V wave, with no interference with the mechanical mitral leaflets (Supplemental Video 2). A 5F sheath was then inserted in the right femoral artery. Aortogram showed significant AR with a significant jet coming from the NCC (Figure 2, Supplemental Video 3). The perforated site of the NCC was crossed with a Terumo wire (Figure 3, Supplemental Video 4). A multipurpose catheter was advanced through the perforated cusp (Supplemental Video 5), and an AVP IV 8 mm was deployed successfully (Supplemental Video 6), resulting in significant decrease in AR on TEE and fluoroscopy (Supplemental Videos 7 and 8). The AMPLATZER family we typically use for closure of leaks are the AVP II, AVP III, and AVP IV (Figure 4). The AVP II and III have a larger profile, are bulkier, and are considered a good choice for aortic/mitral PVL leaks depending on whether the defect is circular or crescentic. For the aortic perforation, we opted for the lowest profile and softest profile that goes through a 5F diagnostic catheter with 2 heads that seals on both sides. Given that the aortic valve will open and close all the time, we believed that the AVP IV will be the least traumatic device.1Lopera J.E. The amplatzer vacular plug: review of evolution and current application.Semin Intervent Radiol. 2015; 32: 356-369https://doi.org/10.1055/s-0035-1564810Crossref PubMed Scopus (37) Google ScholarFigure 3Transesophageal echocardiography: Wire crossing the noncoronary cusp.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Family of AMPLATZER Vascular Plugs. (a) AVP II, (b) AVP III, and (c) AVP IV.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Aortic valve leaflet defects are usually managed by the surgical approach. To our knowledge, this is the first description of a retrograde closure of an aortic valve cusp perforation through percutaneous approach with the AVP IV device. One month after the procedure, our patient’s symptoms improved with resolution of the hemolytic anemia and back to New York Heart Association I class. Consent was obtained from the patient for publication of this report and any accompanying images. The authors have no funding to report." @default.
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• W4224011670 date "2022-04-01" @default.
• W4224011670 modified "2023-10-04" @default.
• W4224011670 title "Transcutaneous Closure of Aortic Valve Cusp Perforation" @default.
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• W4224011670 doi "https://doi.org/10.1016/j.shj.2022.100013" @default.
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