What is paravalvular leak?
In patients whose heart valve has previously been surgically replaced, it is a condition that occurs as a result of wear and tear in the stitches used to fix the valve to the heart and the resulting leakage. Although it is mostly seen in the mitral valve, it can also be seen in the aortic and tricuspid valve.
How is paravalvular leak diagnosed?
In patients who have had valve replacement before, your doctor may suspect paravalvular leak if shortness of breath, unexplained weight gain, and swelling in the legs occur due to heart failure. Sometimes small leaks may not cause heart failure. However, it may cause hemolytic anemia (anemia due to the breakdown of blood cells). In this case, there is a need for frequent blood transfusion. The diagnosis of paravalvular leak is made by echocardiography. Transesophageal echocardiography is the gold standard diagnostic method. Sometimes cardiac tomography or cardiac MRI may be performed to view the shape of the leak, especially as it helps in the procedure plan.
How is PERCUTANEOUS TRANSCATETER PARAVALVULAR LEAK CLOSING performed?
The main method in the treatment of paravalvular leak is open heart surgery. However, nowadays, closure can be performed by experienced cardiologists with interventional methods. The closure procedure is decided as a result of evaluations made with echocardiography and clinical findings. The closing device is determined by the shape and size of the hole around the cover. After the device is determined, the sheath is placed through the inguinal vein for mitral valve paravalvular leak closure, and the sheath is inserted through the inguinal artery for the aorta. To close the mitral valve leak, a needle is passed from the right side of the heart to the left heart. A specially shaped catheter is advanced through this hole and reached around the mitral valve. Other auxiliary catheters are advanced through this catheter and guide wires are sent through these catheters to try to pass the hole around the valve. After passing the hole around the cover, the catheter system is passed through the hole. After the wires are removed, a closure device is placed inside the carrier catheter. The position of the closure device is checked by transesophageal echocardiography and angiography. It is placed according to the sewing technique. After the device is left in place, it is checked whether the leakage has disappeared or decreased. If both heart valves are metallic prostheses, the heart itself is entered with the help of a needle. This procedure is performed through a joint procedure of cardiovascular surgery and cardiology. It requires general anesthesia and your doctor will also inform you if this procedure is planned.
Closing aortic valve paravalvular leak is easier than mitral valve leaks. It does not need to be pierced with a needle to move from the right to the left side of the heart. Generally, the prosthetic valve in the aortic position is accessed by entering through the inguinal artery, and the device is placed with the help of a catheter system and wires similar to the mitral valve. After the device is placed, the leakage status is checked by angiography and echocardiography.
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