Percutaneous Closure of Mitral Paravalvular Leak
A 63-year-old man presented with increasing shortness of breath and hemolytic anemia several months after mitral valve replacement. Transthoracic echocardiogram was performed and showed a bioprosthetic mitral valve and mitral regurgitation; however this could not be well localized or quantified. Further evaluation was done using transesophageal echocardiography (TEE), which showed severe mitral paravalvular leak (PVL) (figure 1).
Figure 1 Initial Assessment (Transesophageal Echocardiogram)
A, B: Two dimensional color Doppler image showing the mitral bioprosthetic valve (yellow arrow) and a turbulent jet of mitral paravalvular regurgitation (PVL, dashed red arrow). The para valvular origin of the jet is clearly depicted (see also video 1).
C: Real-time 3D color Doppler image showing the mitral bioprosthetic valve and the turbulent jet of mitral paravalvular regurgitation in similar orientation as 1B (bioprosthesis yellow arrow, PVL dashed red arrow) (see video 2).
What is the location of the PVL (what would you tell the surgeon/interventionalist)?