No Cut, Just Close: Transcatheter Device Closure of Mitral Paravalvular Leak

Paravalvular leaks (PVLs) are increasingly recognized after valve replacement procedures, resulting from factors such as incomplete sealing, suture dehiscence, or annular calcification. Mitral PVLs are particularly common and can lead to symptoms ranging from mild dyspnea to severe heart failure. While surgical repair remains the traditional approach, transcatheter PVL closure has emerged as a less invasive alternative, offering comparable outcomes with reduced procedural risks. This technique is guided by advanced imaging modalities, with three-dimensional trans esophageal echocardiography (TEE) serving as the gold standard for assessing leak location, size, and severity. Recently, devices have been developed specifically for PVL closure, demonstrating high technical success rates and favorable post-procedural outcomes. The procedure can be performed via antegrade or retrograde approaches, depending on the leak's anatomy, and is associated with a low incidence of complications such as device embolization or stroke. Overall, percutaneous PVL closure represents a promising strategy, particularly for patients with suitable anatomy and contraindications to surgery, leading to significant improvements in symptoms and quality of life.