How is paravalvular leak diagnosed?

A paravalvular leak is suspected if the patient has had a heart valve replacement and shows signs and symptoms of heart failure. The symptoms include shortness of breath, swelling in their legs and feet, fatigue, palpitations (awareness of one's own heart beat). Smaller paravalvular leaks may just present with symptoms of anemia caused by hemolysis due to the destruction of the red blood cells going through the defect between the artificial valve and the surrounding tissuewhich may require frequent blood transfusions, Echocardiography (Echo) is used to diagnose a paravalvular leak. Special types of echo, such

Transoesophageal echo (TEE) 2-D or 3-D echo may be needed to confirm the diagnosis.

Who is at risk for paravalvular leak? Patients are at increased risk for paravalvular leak if:

• They have had the same valve replaced multiple
• They are being treated for endocarditis times
• They have severe calcification of the valve annulus (the ring around the valve)

What are the treatment options for patients with paravalvular leak?

This type of leak was traditionally repaired by a redo open heart surgery which itself entails a higher risk. Today, however, Interventional Cardiologists can use nonsurgical catheter-based treatment techniques to correct these leaks with various devices that plug this leak.

Closure of a paravalvular leak

Outcomes After Paravalvular Leak Closure

In case the paravalvular leak is large for a single closure device, two delivery catheters can be advanced through the defect and two closure devices can be deployed simultaneously.

The procedure entails a catheter which is inserted by a key hole opening in the groin (leg) reaching the heart, whilean apical approach may be needed depending on the valve involved and the position of the leak, where the catheter is placed into the left side of the heart, through the chest wall, and a special catheter is used to place a closure device around the leak. In most cases, the procedure is done using a combination of local anaesthetic and conscious sedation. At Narayana Hrudayalaya, Bangalore this procedure is done in a catheterization lab and for the Apical approach in a special Hybrid procedure room.

Safe and Effective

Dr. Uday B Khanolkar, Senior Interventional Cardiologist at Narayana Hrudayalaya, Bangalore hassuccessfully performed numerous paravalvular procedures over the years. This procedure is an effective and less invasive treatment than surgery with a shorter hospital stay and early symptomatic relief.