Percutaneous treatment of aortic prosthesis with dual dysfunction: A case report

• Para valvular leak (PVL) and stenosis degeneration prosthetic valve is rare complication • Valve in valve TAVI is a real alternative for failed biological valves, with a number of challenges such as increased potential risk of coronary occlusion, high residual gradients and valve thrombosis. • The percutaneous closure of the PVL represents an effective approach, although it is a real challenge. • Addressing both paravalvular leak closure and prosthetic valve degeneration percutaneously in a single procedure represents a major diagnostic challenge. This requires meticulous planning, with cardiac CT and transesophageal echocardiography playing a fundamental role.