Transcatheter paravalvular leak closure using a 10x7 mm Amplatzer plug achieved trivial residual leak, symptomatic improvement, and reduced aneurysm diameter to 5.7 cm at 3 months in a high-risk male.
Case Report (n=1)
Does transcatheter paravalvular leak closure improve symptoms and reduce aneurysm diameter in a high surgical risk patient with severe paravalvular leak and ascending aortic aneurysm?
Transcatheter paravalvular leak closure can be a safe and effective initial step in a hybrid management strategy for high-risk patients with severe paravalvular leak and concomitant aortic aneurysm.
Abstract Introduction Paravalvular leak (PVL) is a clinically significant complication following valve replacement, often leading to heart failure and hemolysis. Management options include redo valve surgery or transcatheter PVL closure (TPLC) using Amplatzer devices. While redo sternotomy remains the standard for complex cases, it carries substantial risk, particularly in patients with multiple prior surgeries or comorbidities. The Bentall procedure addresses concomitant aortic root and valve pathology but may be prohibitive in frail or high-risk individuals. We present a case illustrating a successful hybrid management strategy for severe PVL and ascending aortic aneurysm in a patient unsuitable for surgical intervention. Case Presentation An 80-year-old male with a history of patent ductus arteriosus repair (ages 7 and 18), endocarditis at 68 complicated by aortic regurgitation requiring bioprosthetic valve replacement, paroxysmal atrial fibrillation, heart failure with mildly reduced ejection fraction (45-50%), and ascending aortic aneurysm (6.0 cm) presented with progressive heart failure symptoms. Transthoracic and transesophageal echocardiography revealed moderate-to-severe PVL with preserved prosthetic valve function. Given his three prior sternotomies and comorbidities, the patient was deemed unsuitable for Bentall surgery. A multidisciplinary heart team—comprising interventional cardiology and cardiothoracic surgery—opted for transcatheter PVL closure as the initial step. The defect was successfully sealed with a 10 × 7 mm Amplatzer vascular plug, achieving trivial residual leak. At 3-month follow-up, the patient demonstrated marked symptomatic improvement and a reduction in aneurysm diameter (to 5.7 cm). He was subsequently referred for elective aneurysm repair evaluation. Discussion PVL affects 2-10% of patients with prosthetic aortic valves. Severe leaks commonly result in heart failure, warranting intervention. Reoperative surgery carries high morbidity and mortality, while percutaneous closure offers a less invasive and effective alternative for high-risk individuals. Procedural success depends on anatomical assessment through multimodality imaging. Predictors of mortality include baseline renal dysfunction, advanced NYHA class, and residual regurgitation. In this case, a staged hybrid strategy—initial TPLC followed by delayed surgical aneurysm management—optimized outcomes while minimizing procedural risk. Conclusion Transcatheter PVL closure using Amplatzer devices represents a safe and effective option for high-risk patients with significant regurgitation. A hybrid, multidisciplinary approach can provide durable symptomatic and structural improvement in complex cases otherwise unsuitable for surgery. This abstract is funded by: N/A
Gill et al. (2026) conducted a case report in Paravalvular leak and ascending aortic aneurysm (n=1). Transcatheter paravalvular leak closure using Amplatzer vascular plug was evaluated on Symptomatic improvement and reduction in aneurysm diameter. Transcatheter paravalvular leak closure using a 10x7 mm Amplatzer plug achieved trivial residual leak, symptomatic improvement, and reduced aneurysm diameter to 5.7 cm at 3 months in a high-risk male.