Maladies cardiovasculaires et diagnostic

Paravalvular Leaks with Iatrogenic Ventricular Septal Defect in a Patient with Double Valve Replacement: A Case Report

Abstract

Tabbah R, Rachoin R, Sawaya F, Harb B and Saroufim K

Background: Para-prosthetic leaks post valvular replacement is a relatively rare complication. Burden of mortality and morbidity and recurrence increase with reoperation. Hemolysis is commonly seen in paravalvular leaks (PVL). Transcatheter repair is a less invasive technique with lower procedural mortality risk.

Case presentation: A 59-year-old male patient, presented to his primary physician for dyspnea on exertion with no known previous medical history. Cardiac ultrasound revealed an aortic and mitral valve disease. A severely calcified aortic valve with a moderately severe aortic regurgitation grade II to III and an aortic area of 1.3 cm2. On the other hand, a severely calcified mitral valve mainly the anterior leaflet and a severe mitral regurgitation grade III with a mean gradient of 7 mmHg. Patient was sent for surgery. Two months after, patient presented with signs of heart failure and hemolytic anemia. Transesophageal echocardiography (TEE) revealed a severe eccentric paravalvular mitral leak aiming to the left atrial appendage, with several paravalvular aortic leaks moderate to severe and a small ventricular septal defect. Transcatheter repair was done for the mitral paravalvular leak, 3 plugs were needed and yield excellent results, with one plug for the aortic paravalvular leak. Patient symptoms were better.

Discussion: In this case, we illustrate the need for TEE with 3D TEE to have a more accurate diagnosis of postoperative complications. Always think about post-operative leaks in the setting of hemolytic anemia. Furthermore, a wider use of the transcatheter techniques to reduce mortality and morbidity due to surgery.