Simultaneous Closure of Left Atrial Appendage and Mitral Paravalvular Leak

BACKGROUND: An 81-year-old man with 2 prior mitral valve replacements developed recurrent symptomatic paravalvular leak (PVL) despite prior transcatheter closure with vascular plugs. He had ongoing heart failure hospitalizations and hemolytic anemia that limited uninterrupted anticoagulation in the setting of atrial fibrillation and high thromboembolic risk. CASE SUMMARY: The patient underwent a combined procedure with redo PVL closure and left atrial appendage occlusion. Given close anatomic proximity of the lateral PVL to the appendage ostium, a Watchman FLX Pro device was deployed to achieve both left atrial appendage occlusion and sealing of the lateral PVL. Postprocedure, mitral PVL resolved, hemolysis improved at 1-month follow-up, and PVL closure was durable on 3-month follow-up transesophageal echocardiography. DISCUSSION: To our knowledge, this is the first report of Watchman device use for mitral PVL closure. In high-surgical risk patients with atrial fibrillation and bleeding limitations, this single-device strategy may simplify treatment and reduce the need for additional interventions.