Paravalvular Leak Closure

A paravalvular leak can happen when there is a space between the patient’s natural heart tissue and a valve replacement. This only occurs in a small number of patients who have had a valve replacement. This can affect the mitral, aortic, or tricuspid valve.

Paravalvular leak closure can be done with a nonsurgical, catheter-based procedure. This avoids having to do a repeat heart surgery.

The doctor will insert a catheter in the femoral vein in the groin. A wire is guided to the upper left chamber of the heart (left atrium), using a technique to go through the septum (the muscular wall that divides the heart's upper chambers). The catheter places a closure device around the leak to stop any backflow of blood.

If a patient has two mechanical valves in place, the doctor may use an apical approach rather than the femoral artery. An apical approach involves placing the catheter into the left side of the heart, through the chest wall, also without making an incision.

Why choose Presbyterian for your paravalvular leak closure?

Presbyterian Heart and Vascular Care has a team of highly-skilled surgeons who are using some of the most advanced techniques to perform this procedure. These techniques can improve recovery time, reduce complications and provide a quicker return to work and other daily activities.

Who is eligible for a paravalvular leak closure?

Patients may have a paravalvular leak if:

• They are being treated for endocarditis.


• They have had the same valve replaced multiple times.


• They have severe calcification of the valve annulus (the ring around the valve).

Echocardiography is used to diagnose a paravalvular leak. Special types of echo, such as transesophageal echo (TEE) or 2-D or 3-D echo, may be needed to confirm the diagnosis and plan the treatment.

What conditions can be treated with a paravalvular leak closure?

Patients with a paravalvular leak closure may have a heart murmur or severe anemia (low iron). If there is a larger leak, they may have symptoms of heart failure, which include symptoms like:

• Shortness of breath.


• Swelling in feet and legs.


• Unexpected and rapid weight gain.

Sometimes small paravalvular leaks may cause a particular kind of anemia called hemolytic anemia. This is caused by the destruction of the red blood cells going through the hole between the artificial valve and the surrounding tissue.

How do I prepare for a paravalvular leak closure?

Your doctor and treatment team may give you specific instructions to follow during your recovery when returning home.

Talk to your doctor about:

• When you should stop eating or drinking the night before the surgery.


• When you can take your regular medications and whether you can take them before your surgery.

Your treatment team may recommend that you bring:

• A list of your medications.


• Loose, comfortable clothing.


• Eyeglasses, hearing aids, or dentures.

What should I expect during my paravalvular leak closure?

In most cases, the procedure is done using a combination of local anesthetic and conscious sedation.

During the procedure, your cardiologist will:

• Insert a catheter into the femoral artery or vein in your groin.


• Use advanced imaging techniques to guide the catheter to your heart.


• Place the closure device (plug) on the leak.


• Remove the catheter from your blood vessel.

Our cardiac team monitors your recovery closely.

How do I care for myself after my paravalvular leak closure?

Three months after the procedure, your cardiologist may conduct another TEE to assess the position of the closure device and any residual leaking. Eventually, your heart tissue will grow around the plug, and it becomes part of your heart.

Your doctor will discuss when you can return to activities such as working, driving, and exercise. You'll need to attend regular follow-up appointments with your doctor. You may have several tests to evaluate and monitor your condition.

Your doctor may instruct you to follow these healthy lifestyle changes:

• Reduce salt in your diet.


• Maintain a healthy body weight.


• Never smoke, or stop smoking.


• Drink only moderate amounts of alcohol, if any. This means an average of one to two drinks per day for men and one drink per day for women.


• Eat a healthy, well-balanced diet, rich in fresh fruit and vegetables but low in saturated fats, processed sugar, and salt.


• If you have diabetes, work closely with your doctor to make sure it is controlled.


• Get at least 150 minutes of moderate to intense physical exercise every week.