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European Journal of Echocardiography Advance Access originally published online on March 2, 2009
European Journal of Echocardiography 2009 10(4):576-578; doi:10.1093/ejechocard/jep018
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Symptomatic paravalvular leakage after mechanical aortic valve replacement in a critically ill patient: why not just "plug" the hole?

C. Hammerstingl*, N. Werner and G. Nickenig

Medizinische Klinik II, Universitätsklinikum Bonn, Sigmund-Freud Strasse 25, 53105 Bonn, Germany

Received 27 November 2008; accepted after revision 10 February 2009; online publish-ahead-of-print 2 March 2009.

* Corresponding author. Tel: +49 228 2871 6137; fax: +49 228 2871 4907. E-mail address: christoph.hammerstingl{at}ukb.uni-bonn.de


  Abstract

We report on an 81-year old man with decompensated severe aortic regurgitation due to a large paravalvular leakage of mechanical aortic valve prosthesis. Because of relevant co- morbidities the patient was unable to undergo cardiovascular surgery. Non- invasive imaging allowed exact localization of the leakage and sizing of the defect diameter; therefore, we decided to perform interventional closure of the defect using the Amplatzer Vascular Plug III device. The intervention was guided by transoesophageal echocardiography. Afterwards the patient's medical condition improved continuously. Follow up echocardiography showed stepwise decrease in severity of aortic valve insufficiency. These findings illustrate, first, that echocardiography is extremely helpful to select patients which may benefit from interventional closure of a paravalvular leakage after valve replacement. Secondly, non-invasive imaging is indispensable during such a complex intracardiac procedure to guide the intervention. Thirdly, the TEE findings during follow-up demonstrate nicely that acute implantation of the device is followed by a subsequent ‘healing’ process (including thrombus/scar formation and endothelialization) which is mainly responsible for successive defect closure.

Keywords: Mechanical heart valve replacement; Paravalvular leakage; Interventional device closure; Transesophageal echocardiography


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