Management of massive paravalvular leak (PVL): a case report of transcatheter mitral paravalvular leak closure

Paravalvular leak (PVL), a complication following either surgical or transcatheter prosthetic heart valve replacement, can lead to severe clinical consequences including refractory heart failure and persistent hemolysis. Transcatheter paravalvular leak closure (TPVLC) represents an effective therapeutic option for PVL management; however, clinical experience remains relatively limited, particularly regarding its application in cases of massive paravalvular leaks, where reported cases managed with a single occluder are notably scarce. We present a 69-year-old female with rheumatic heart disease complicated by mitral stenosis with regurgitation, severe tricuspid regurgitation, NYHA III heart failure, and persistent atrial fibrillation. Seven months prior to the current procedure, the patient underwent Bioprosthetic mitral valve replacement, tricuspid annuloplasty. During follow-up, she developed progressive exertional chest pain. Three-Dimensional Transesophageal echocardiography (3D-TEE) revealed: (1) recurrent moderate tricuspid regurgitation, and (2) severe paravalvular leak (14 × 7 mm) around the mitral prosthesis. Following comprehensive evaluation by the heart team, the patient underwent transcatheter mitral paravalvular leak closure, which was successfully completed with the implantation of a single 22 –16 mm AVPII occluder. Post-procedural 3D-TEE assessment demonstrated near-complete resolution of the paravalvular leak and a significant improvement in tricuspid regurgitation. The patient recovered well and showed marked improvement in cardiac function over nearly one year of follow-up. This case successfully confirms the technical feasibility of using a single occluder for TPVLC in treating such massive PVLs and provides valuable experience for the clinical management of similar cases.